First Baby in Puerto Rico With Zika-Related Microcephaly Born

The first child in Puerto Rico with Zika-related microcephaly has been born, the territory’s secretary of health announced Friday.

The fetus’s abnormally small head was not detected until the mother was nearly eight months pregnant, according to The Associated Press, even though the mother was probably infected in her second month.

The mother did not get regular prenatal checkups, the AP quoted the health secretary, Dr. Ana Rius, as saying.

The baby, born within the last two weeks, is still hospitalized with severe birth defects, including vision and hearing problems.

The first case of Zika infection in Puerto Rico was reported last December, but the virus spread slowly for months before exploding into thousands of cases in early summer, when the Centers for Disease Control and Prevention estimated that as many as 50 women a day could be getting infected.

Puerto Rico’s policy is that pregnant women there with Zika symptoms should be seen by a doctor at least three times during a pregnancy, with fetal ultrasounds each time.

The C.D.C., which is underwriting much of the territory’s Zika-fighting efforts, said Friday that the child would be monitored until he or she was 3 under the Zika Active Pregnancy Surveillance System, as are all children born to mothers infected with Zika.

Sometimes babies infected in the womb with viruses like rubella or cytomegalovirus appear normal at birth, but later turn out to have serious problems with hearing, vision or learning, and officials want to know if Zika carries the same risks.



By DONALD G. McNEIL Jr.
First Baby in Puerto Rico With Zika-Related Microcephaly Born

Why Zika has infected so many people in Puerto Rico

The United States declared Zika a public health emergency in Puerto Rico in August 2016.

Over 28,000 cases of Zika were reported in Puerto Rico as of Oct. 26. In contrast, just over 4,000 cases of Zika were reported in the continental U.S. and Hawaii by the same date. Most of these cases are travel-related, meaning that people are infected while abroad. But in Puerto Rico, 98 percent of Zika cases are locally acquired. It is estimated that up 80 percent of people who are infected with Zika are asymptomatic, which means that reported cases may be just a fraction of those who may be infected.

The U.S. Surgeon general Officials said that one in four Puerto Ricans could be infected by the end of the year. A recent study by the Centers for Disease Control and Prevention estimated that 5,900 to 10,300 pregnant women might get infected during the initial Zika outbreak in Puerto Rico. In the absence of effective interventions like birth control or mosquito control, about 100 to 270 infants may be born with Zika-related microcephaly from mid-2016 to mid-2017.
So why is Zika so much worse in Puerto Rico than in the continental U.S.?

Mosquito-borne diseases are complex. Environmental, social, political and cultural factors can influence their transmission. And Puerto Rico, like other parts of the Caribbean and Latin America, has the perfect mix of conditions for a mosquito borne virus to spread widely.

Since the Zika virus was identified in Brazil, it has spread through most of the countries in the Western Hemisphere, Latin America and the Caribbean, including the continental United States. All these areas have something in common: the Aedes aegypti mosquito.

Ae. aegypti mosquitoes can also transmit Chikungunya and dengue viruses. This species is prevalent in Puerto Rico, where temperature, humidity and rainfall make it a perfect place for mosquitoes to breed all year long.

By contrast, in most of the states in the continental U.S., these environmental conditions are met just at the end of spring and during summer (though this is slowly shifting over time, thanks to climate change).

The only state with confirmed local transmission of Zika virus is Florida, and transmission there is occurring in only two areas in Miami-Dade County. Up to Oct. 26, 2016, 180 local related Zika infections have been confirmed.
But it is expected that with the lower temperatures during winter the risk of Zika will also decrease, because mosquitoes need optimal temperatures to reproduce.

Ae. aegypti mosquitoes like to feed on people, and often breed in stagnant water in households or in areas near where people live.

In areas without infrastructure to supply water to the entire population or with inappropriate waste management, people may store water in or near their homes or leave waste containers and tires uncovered. This can create more breeding sites for the mosquito. More mosquitoes means more mosquito bites.

In Puerto Rico, Aedes mosquito-breeding sites are mainly used and discarded car tires, which the government is trying to collect to reduce mosquito densities and contain the spread of the virus. Pails, pets’ water bowls and water fountains, for example, also contribute to the problem.

Population growth and internal migration, particularly to unplanned urban areas with poor sanitary conditions, can move more people into areas where Ae. aegypti mosquitoes densities are higher. This is characteristic of Latin America and the Caribbean overall.

In Puerto Rico, as in other tropical areas, window and door screens and air conditioning aren’t as common as they are in the continental U.S. These are considered luxuries for most of the medium and low socioeconomic classes. Simple things like window screens, use of repellent or air conditioning make a difference.

As part of Zika prevention efforts, the government of Puerto Rico is installing or repairing window and door screens in low-income households with pregnant women and women of childbearing age within the public housing system.

The most effective way to prevent mosquito-borne diseases is to control mosquito densities. But mosquito control strategies, such as insecticides and elimination of potential breeding sites, are unsustainable and ineffective in complex transmission settings like Puerto Rico and other tropical areas.

For instance, health officials have known these breeding sites are a major factor in the spread of mosquito-borne illnesses in Puerto Rico for a long time. But efforts to eliminate these sites and control the spread of diseases have not been successful due to multiple environmental and social conditions that make the ideal setting for the mosquito to breed and difficult to control.

In contrast, in the U.S. the mosquito densities are low and the population takes action in doing its own pest and mosquito control, reducing the mosquito populations that can lead to an outbreak.

The fact that mosquito-borne infections are so common in Puerto Rico means that perceived risk from Zika is low. Dengue, for instance, is endemic in Puerto Rico. If Zika is not perceived as a high risk, that means many people do not use repellent or wear long sleeves and long pants as additional protection against mosquito bites.

Puerto Rico’s ongoing economic crisis has weakened the island’s health sector, which can lead late detection of outbreaks, delaying control strategies.

However, the Zika funding bill Congress passed on Sept. 28 allocated money to fight the virus, as well as to support Medicaid and local health centers in Puerto Rico. This funding may help control transmission of the virus (mosquito control) and fund preventative efforts, like vaccine development.

It’s possible to reduce mosquito-borne diseases, even in places where the conditions are ideal for mosquitoes like Ae. aegypti to flourish. Getting rid of standing water – even small amount in flower pots or bird paths – eliminates places where female mosquitoes lay their eggs. Installing window screens and mosquito repellent can keep mosquitoes at bay.

This article was originally published on The Conversation. Read the original article.

Diana Rojas, University of Florida
Why Zika has infected so many people in Puerto Rico

Patients left in limbo as more doctors flee Puerto Rico

Wanda Serrano arrived at Puerto Rico's largest public hospital before dawn to take her 17-year-old son to an appointment. Six hours later, they were still in the packed waiting room hoping to see a doctor.

They had gone to San Juan's Centro Medico to see one of the many kinds of specialists the teen needs for treatment of a genetic disease called tuberous sclerosis, which can cause tumors to grow on his brain, kidneys and other organs. But specialized medical expertise is increasingly difficult to find in the economically troubled U.S. island territory.

Six hours in a waiting room is no longer the exception, but the norm. A pediatric neurologist recently told Serrano that her son, Cedrik, needed to wait 10 months for an appointment.

"I live terrified every single day," Serrano said one recent morning as she clutched his medical records and peered anxiously down a fluorescent-lit hallway for a nurse or doctor. "You feel powerless. You can't do anything except wait for that date to arrive."

Doctors have gradually left Puerto Rico during a decade-long recession that has gripped the island and driven more than 200,000 people to the U.S. mainland seeking better opportunities.

Now, the steady departure of pediatricians, surgeons, orthopedists, neurologists and others has become a stampede as the economy shows no sign of improving and financial problems in the territorial health insurance program make it nearly impossible for doctors to stay in business.

Up to 700 doctors are expected to leave Puerto Rico this year, double the number from two years ago, said Dr. Victor Ramos, president of the island's Association of Surgeons. The territory's number of doctors has dropped from 14,000 to 9,000 in the past decade, the majority leaving for higher salaries and lower living costs on the U.S. mainland.

The island of 3.5 million people now has only two pediatric urologists, one orthopedist specializing in ankle and feet, one pediatric cardiologist, and a handful of geneticists and endocrinologists. It can take a year to see a specialist, Ramos said.

"People are waiting much longer for appointments, including one that could be a matter of life or death because there is simply no room," he said.

Dr. Hiram Luigi, an orthopedic surgeon, said he has to realign the bones of patients a couple of times each month because they did not see a specialist in time.

"I have spent 30 years in orthopedics, and I have never seen something like this," Luigi said.

The lack of specialists has adversely affected patients, whose health conditions often worsen before a doctor sees them.

Many people like Serrano have moved to the U.S. specifically to get medical care. "I'm searching for quality of life," she said.

Puerto Rico's financial woes are largely to blame. The government is behind on insurance payments as it scrambles to make payments on debts that have ballooned in recent years to nearly $70 billion. Doctors not only struggle with delayed reimbursements for services but receive less money through the government's Medicare and Medicaid programs as well as private health insurance than they would for the same services on the U.S. mainland.

Many specialists no longer accept patients with Medicaid, which covers roughly half of Puerto Rico's population. The great majority of patients like Serrano's son now seek specialists at Puerto Rico's largest public hospital, lining up as early as 1 a.m. daily for medical care.

"It's truly the final stop for many people," said Edgar Colon, dean of the University of Puerto Rico's School of Medicine. "We can't keep up."

The hospital is buckling under a surge of patients as it operates with a dwindling budget, unable to buy certain medical supplies like it used to when the government could still borrow money.

Jorge Vidal, president-elect of Puerto Rico's Radiology Association, said he cannot perform some procedures because he can't obtain two types of specialized needles.

"There's a very simple reason they haven't bought them," he said. "They cost $300."

Such problems pushed pediatrician Dr. Hector Nieves to move to Florida in February 2015. In his new office, the answering machine offers same-day appointments.

"I don't regret leaving," Nieves said. "Puerto Rico's problems are much bigger than people think."

Those who have stayed say it will only get worse.

More than 20 percent of the island population is 60 years and older, and that percentage is expected to spike as not only doctors but all types of Puerto Ricans leave for the U.S. mainland.

Serrano and her son will move soon to Orlando to join her husband, who found a job there. She is optimistic about finding specialists to provide the checkups her son needs every six months.

"I'm leaving in peace," she said. "I feel like I've been born again."

BY DANICA COTOAssociated Press


In this Oct. 24, 2016 photo, patients wait their turn at one of the Medical Center external clinics in San Juan, Puerto Rico. A steady departure of medical specialists from Puerto Rico has turned into a stampede amid the island's ongoing economic crisis leaving patients with few doctors to take care of their ills. Carlos Giusti AP Photo

Read more here: http://www.newsobserver.com/news/article110742012.html#storylink=cpy

Patients left in limbo as more doctors flee Puerto Rico

UPDATE: Census Bureau to Participate in Puerto Rico Statistics Events

WASHINGTON, Oct. 13, 2016 /PRNewswire-USNewswire/ -- What: The public and members of the media are invited to learn how to use and access U.S. Census Bureau statistics to make informed decisions about their communities.

View photos

U.S. Census Bureau Logo

¡Puerto Rico Cuenta! (Puerto Rico Counts!) is a one-day conference about data usage that will take place Oct. 14, 2016, in partnership with the Instituto de Estadísticas de Puerto Rico and Universidad del Sagrado Corazón. This event will include a series of data workshops focusing on data for public and private sectors, organizations, academia and the public.

For more information and to register for ¡Puerto Rico Cuenta!, click here.

When: Friday, Oct. 14, 2016, from 8 a.m.-5 p.m. Atlantic Standard Time

Where: Universidad del Sagrado Corazón (Sacred Heart University)Innovation CenterC11 Sagrado Corazon De JesusSan Juan, 00912, Puerto Rico

RSVP: Media who plan to attend should contact the Census Bureau's Public Information Office at pio@census.gov or 301-763-3030.

For media who are interested in an interview, please contact the Census Bureau's Public Information Office at pio@census.gov or 301-763-3030.

UPDATE: Census Bureau to Participate in Puerto Rico Statistics Events

Madagascar : le secret de beauté d'Yves Rocher

Paris Match | Publié le 08/10/2016 à 07h30

Anne-Cécile Beaudoin

Surnommé « Guérit-vite », Sigesbeckia orientalis est récolté d’avril à juin dans la région de Moramanga, à l’est de Tananarive .RIJASOLO/RIVA PRESS

Connues pour leurs vertus médicinales, les plantes malgaches figurent parmi les ingrédients stars des soins de la marque. Voyage sur la Grande Ile au cœoeur de ses filières végétales, dans le respect de la biodiversité et des hommes.

our s’endormir le soir, Xavier Ormancey, le directeur de la recherche et du développement d’Yves Rocher, ne compte pas les moutons mais les pays qu’il a traversés : le Mexique, la Chine, le Vietnam, le Bhoutan, l’Inde, le Brésil… Son esprit s’attarde sur les bords du fleuve Jordão, dans l’Etat de l’Acre, lové entre le Pérou et la Bolivie. Là-bas, il avait participé à une mission digne d’« Indiana Jones », s’était initié au chamanisme avec les Indiens Kaxinawa afin de percer les secrets de la forêt – pharmacopée à ciel ouvert – et de réaliser une encyclopédie botanique. Cette nuit, ses rêves débutent au seuil de Madagascar. Une aube pâle éclaire la canopée. Le long des sentiers, les feuillages bruissent. Il salue les lémuriens au ventre roux, puis s’enfonce dans les entrailles du monde végétal. (Lire aussi : Pour l'amour des enfants de Madagascar)

La région de Moramanga, à l’est de Tananarive.© Nanouh Rahajason

Fondu d’or vert, Xavier parcourt le globe en quête de nouvelles matières premières et pilote une équipe pluridisciplinaire de 150 chercheurs. Ce scientifique est comme les plantes : il s’épanouit loin du cadre aseptisé des laboratoires. Sa passion est née quand il était gamin, à Ormancey, son village natal niché entre la Bourgogne et la Champagne. Son grand-père, garde champêtre, avait réalisé avec l’instituteur le premier herbier de la région. Xavier avait aussi une grand-tante un peu sorcière qui glanait des herbes pour soigner les villageois. « Plus tard, j’ai voulu comprendre les pouvoirs des plantes », se souvient-il. Diplômé de l’Ecole nationale supérieure de chimie de Montpellier, cet ingénieur baroudeur exerce chez L’Oréal, Chanel et enfin Yves Rocher depuis 2011. Pionnière de la beauté par les plantes, la marque lui va comme un gant. Elle fait rimer soin avec souci de l’environnement. Le monde est devenu son jardin. Depuis son arrivée, Xavier a mis en place le programme des « VIP » (« Very Importantes Plantes ») afin de lister tous les végétaux aux propriétés prometteuses. Il explique : « Notre expertise est basée sur le génie du végétal. Il s’agit de décrire les capacités exceptionnelles des plantes. En effet, chacune possède son génie : celui de la vie, de l’architecture, de l’adaptation, de la séduction, de la conquête et de la communication. L’idée est donc de comprendre comment ce génie fonctionne pour transposer ses principes à la peau. » (Lire aussi : Jacques Rocher - "Nous avons mis 7 ans pour planter 50 millions d'arbres")

La récolte de l'Aphloïa est assurée à 80 % par des femmes© Nanouh Rahajason

Parmi les 250 filières végétales d’Yves Rocher à travers la planète, Madagascar est une pépite. Dotée d’une fantastique biodiversité (85 % des espèces animales et végétales n’existent nulle part ailleurs), la Grande Ile regorge de plantes magiques. On compte 14 000 espèces, dont 6 500 ont un usage médicinal. Il faut avoir l’œil pour ramasser un trésor. Près du village de Morarano, à l’est de l’île, des hommes sont penchés sur les rizières, tandis que les femmes cueillent des fleurs discrètes et délicates, aux faux airs de minuscules nénuphars, qui somnolent au milieu des herbes folles. Il s’agit de Centella asiatica. Bouillie et infusée, cette plante est utilisée depuis le XIXe siècle pour soulager des méfaits de la lèpre. Elle abonde en asiaticoside et en madécassoside, des molécules aux pouvoirs raffermissants. « Nous en avons fait l’ingrédient star de notre gamme minceur », dit Xavier Ormancey. La plupart du temps, les chercheurs mettent la main sur une plante aux vertus connues des populations locales. C’est le cas de Sigesbeckia orientalis. Originaire des Indes, il s’épanouit sur le bord des chemins ou sur les terrains riches en humus, disperse ses graines aussi bien à Madagascar qu’en Australie et en Polynésie. En malgache, son nom signifie « Je veux encore être blessé pour en profiter » ; en créole, on le surnomme « Guérit-vite ».

Des règles d’APA – Accès et partage des avantages – ont été mises en place avec les communautés

Cette plante possède en effet des propriétés singulières. Feuilles, tiges, fleurs sont utilisées traditionnellement pour traiter les maladies de peau : eczéma, acné, gale… Les Malgaches s’en servent aussi pour soulager les brûlures et les plaies. Il faut mâcher quelques feuilles, puis les appliquer comme un cataplasme pour calmer la douleur et activer la cicatrisation. « C’est le génie de la vie, décrypte Xavier Ormancey. La gomme-résine que contient le Sigesbeckia est riche en terpène et en molécules de la famille des polyphénols, ce qui lui confère des pouvoirs apaisants et cicatrisants. Cette plante synthétise ses principes actifs pour les envoyer à ses feuilles lorsqu’elle est soumise à des stress externes. » Ainsi Sigesbeckia orientalis est-il entré dans les grimoires d’Yves Rocher pour ses vertus apaisantes et réparatrices. « Nous l’avons intégré à notre gamme Sensitive végétal, à destination des peaux ultrasensibles qui souffrent de rougeurs, de tiraillements et d’échauffements. »

Cueillette de l'Aphloïa avec Xavier Ormancey, directeur Recherche et Innovation Yves Rocher (au centre), et Bris Rocher, P-DG du Groupe Rocher.© RIJASOLO/RIVA PRESS

L’Aphloïa aussi est champion de self-défense. Cet arbuste prolifère sur les hautes terres ocre et vertes de Madagascar. Dans la région de Moramanga, à l’est de la capitale Tananarive, les femmes coupent ses feuilles avec délicatesse, uniquement d’octobre à avril, pendant la saison des pluies, pour faciliter son renouvellement. La partie la plus exposée au soleil est celle qui contient le plus de mangiférine. Synthétisée par l’Aphloïa en cas d’agressions extérieures, cette supermolécule agit comme une stratégie de défense pour absorber les rayons ultraviolets. Tous les voyageurs devraient avoir une poignée de ses feuilles au fond de leur sac. Utilisées en infusion, elles ont des vertus dépuratives, diurétiques, fébrifuges et antirhumatismales. Cuites, elles soignent les foulures et les luxations. L’ Aphloïa bénéficie aussi d’une belle capacité de réparation : il fait peau neuve régulièrement en se séparant de son ancienne écorce, ce qui lui vaut le surnom de « Change-écorce ». Remède de santé, l’Aphloïa vient d’entrer en cosmétique. « Il nous a fallu plusieurs années de recherche pour obtenir un concentré très riche en mangiférine, révèle Xavier. Le résultat est un sérum anti-âge léger et fluide qui agit comme un puissant défenseur cellulaire. » Baptisé Elixir Jeunesse, c’est le dernier bébé de la marque.

Un village de cueilleurs, à 100 kilomètres de Tananarive, où les plantes seront mises à sécher.© RIJASOLO / RIVA PRESS

Monsieur Yves Rocher lui-même l’avait prédit : « C’est un fait. Plus la science avance, plus elle donne raison à la nature. » Mais, pour satisfaire 30 millions de clientes dans le monde, pas question de piller la planète ! Afin d’encadrer l’utilisation des végétaux dans ses formules, la marque a mis au point une « charte plante » très stricte au chevet de la biodiversité. On y découvre, par exemple, qu’aucune plante ne peut être utilisée si son avenir ou son environnement est menacé. Interdit aussi de toucher aux espèces protégées. « La clé de la préservation, c’est d’être entouré de gens passionnés, confie Bris Rocher, petit-fils du fondateur et P-DG du Groupe Rocher. Nos experts – botanistes, récoltants… – opèrent avec leur cœur. Vous pouvez avoir autant de chartes que vous voulez ; sans passion, ça ne fonctionne pas. » Les collecteurs veillent donc au grain et les cueilleurs sont formés au prélèvement durable. On ne récolte qu’un tiers des feuilles d’un Aphloïa, par exemple. Idem pour Centella, jamais arraché : afin de préserver ses racines, seules ses feuilles sont coupées du bout des doigts.

S’engager durablement, c’est aussi respecter les hommes. Des règles d’APA – Accès et partage des avantages – ont été mises en place avec les communautés. Séchées au soleil dans les villages des cueilleurs, les plantes sont acheminées à Tananarive chez Sotramex, le partenaire malgache d’Yves Rocher qui contrôle la qualité et conditionne les plantes pour l’expédition vers la France. « Nous participons au financement d’équipements industriels afin que notre partenaire puisse désormais transformer sur place les plantes en extraits », poursuit Xavier Ormancey. Objectifs : augmenter la valeur responsable créée à Madagascar, œuvrer davantage pour l’environnement et les populations locales. Car, malgré l’opulence de la Grande Ile, riche d’or, de pétrole et d’uranium, ses habitants continuent de s’enliser dans la misère. La cueillette et la collecte des plantes sont pour eux un appoint précieux. Protéger, valoriser, partager : c’est par la richesse du cœur qu’Yves Rocher souhaite offrir le meilleur de la beauté.

Connues pour leurs vertus médicinales, les plantes malgaches figurent parmi les ingrédients stars des soins de la marque. Voyage sur la Grande Ile au cœoeur de ses filières végétales, dans le respect de la biodiversité et des hommes.




Anne-Cécile Beaudoin
Madagascar : le secret de beauté d'Yves Rocher