News in brief - Aug. 1, 2005

West Nile emerges for the season - Exercise helps chronic low back pain - Vitamin D regimen for cystic fibrosis - States expand newborn screening

West Nile emerges for the season

As of July 12, the Centers for Disease Control and Prevention had recorded 25 human West Nile Virus cases in 11 states. This tally includes one death. Another 15 states reported animal cases.

"It's impossible to predict what this year's season will hold," said Lyle Petersen, MD, MPH, director of the CDC's division of vector-borne infectious diseases.

The disease emerged initially in New York in 1999 and peaked in 2003, when it caused nearly 10,000 cases and several hundred deaths. It has now been reported in all states except Hawaii and Alaska. About one in 150 people infected with the virus go on to develop serious symptoms, with the highest risk being for those older than 50 or those who have received solid organ transplants.

Public health officials recommended that people utilize strategies to avoid being bitten by any infected mosquitoes.

"Use insect repellant," said Patricia Quinlisk, MD, MPH, Iowa state epidemiologist. "Keep skin covered as much as possible when outdoors and avoid being outside at dawn and dusk when mosquitoes are most active."

Exercise helps chronic low back pain

A program of gradually increasing physical activity can decrease pain, improve function and reduce work absenteeism for those with chronic low back pain, according to a review of the evidence published in the July issue of the Cochrane Database of Systematic Reviews. No such evidence was found to support this strategy for acute cases.

"The accumulated evidence supports a sea change that has occurred in medicine, away from recommending prolonged bed rest and activity restriction," said Michael Von Korff, ScD, senior investigator at the Center for Health Studies in Seattle.

In a related paper, reviewers also failed to find any evidence to support the use of transcutaneous electrical nerve stimulation -- TENS -- even though it is widely used for this condition.

"There may be some place for TENS as a component of treatment for people with chronic low back pain, but there is no evidence on which to base the conclusion that is useful as a solo modality for this population," said Dennis C. Turk, PhD, professor of anesthesiology and pain research at the University of Washington School of Medicine.

Vitamin D regimen for cystic fibrosis

Adults with cystic fibrosis could benefit from higher levels of vitamin D than are currently recommended, according to a study reported in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.

A new vitamin D repletion regimen suggested by the Cystic Fibrosis Foundation's Consensus Panel on Bone Health for replacing the vitamin in people with CF was called "strikingly ineffective," by researchers.

Of 66 adults with CF, only five who had been treated with the recommended 50,000 international units of vitamin D per week for eight weeks had their serum levels corrected to the recommended degree, the researchers said.

Improvements in treatment for people with CF have boosted life expectancy rates and led to increased attention to their other health needs, which include bone health, said Michael P. Boyle, MD, director of the Johns Hopkins University Adult CF Program. Survival rates have increased lifespan from 25 years old in 1985 to older than age 33 this year.

Despite this young age, approximately 20% to 25% of adults with CF have osteoporosis and another 40% have osteopenia, Dr. Boyle said. An adequate supply of vitamin D is needed for the body to absorb calcium from foods and incorporate it into bone.

States expand newborn screening

As of June 1, 23 states had expanded their newborn screening programs to include more than 20 of 29 disorders recommended in the 2005 report by the American College of Medical Genetics, according to a new report by the March of Dimes.

The group recommends that all babies be screened for the 29 disorders that include metabolic conditions and hearing deficiency. "Parents need to know that the extent of newborn screening for serious and treatable disorders depends entirely on the state in which their baby is born," said Jennifer L. Howse, PhD, president of the March of Dimes. "For infants affected with these conditions, the tests can mean the difference between life and death, or health and lifelong disability."

A brochure, "Newborn Screening," contains a list of the 29 disorders and other information and can be ordered from the March of Dimes' Web site (www.marchofdimes.com/pnhec/newbornscreeningbrochure.asp).