MMWR

Morbidity and Mortality Weekly Report

1. State Medicaid Coverage for Tobacco-Dependence Treatments – United States, 2007

Press Contact: Sara McMenamin, PhD, Director of Research, Center for Health and Public Policy Studies
University of California, Berkeley
(510) 643-8524

Medicaid programs should remove barriers to accessing treatments and provide consistent coverage for all Medicaid recipients regardless of their enrollment status. In addition, to reduce smoking rates among low-income populations and meet the 2010 national health goals of expanding coverage of tobacco-dependence treatments to all 51 Medicaid programs, medication and counseling could be included in the federally mandated core Medicaid insurance package.  In the United States, smoking rates among low-income adults enrolled in Medicaid programs are much higher than the general population (33 percent vs.19 percent). Yet, in 2007, only six states provided the recommended full coverage of all tobacco-dependence treatments (FDA-approved medications and counseling) to help smokers quit. Medicaid coverage varied widely among states and among enrollees within the same program. Of all 51 Medicaid programs, 43 programs covered at least one tobacco-dependence treatment, while two programs (Arizona and Washington) offered coverage only to pregnant women. Nearly all, or 41, programs placed restrictions on receiving coverage such as requiring copayments and limiting the number of treatments.

2. Human Vaccinia Infection After Contact with a Raccoon Rabies Vaccine Bait – Pennsylvania, 2009

Press Contact: Christopher Cox
Division of Media Relations           
(404) 271-7133

Dog owners should not attempt to remove baits from a dog’s mouth. Gloves or plastic bags should be used to pick up and examine baits if necessary and additional baits that might be picked up by dogs or other pets should be removed from the immediate area. Individuals who are concerned that they might have been exposed to oral rabies vaccine from a ruptured bait should call the phone number written on the bait or call their local health department.  Vaccination of raccoons (and other wildlife) for rabies is accomplished in the United States using a live, oral vaccine.  The vaccine is distributed in baits, which are ingested by raccoons.  Vaccinia virus is the live component in the oral rabies vaccine. In August 2009, shortly after initiation of the autumn baiting campaign in western Pennsylvania, a woman developed multiple vaccinia virus lesions on her hand approximately five days after coming into contact with the oral rabies vaccine.  Liquid vaccine had dripped onto her skin from a punctured bait that she had retrieved from her dog.  The woman, who had been taking immune suppressive medications to treat inflammatory bowel disorder, was treated with vaccinia immunoglobulin and an investigational anti-viral agent.

3. Human Rabies – Missouri, 2008

Press Contact: Christopher Cox
Division of Media Relations           
(404) 271-7133

Any bat or wild terrestrial carnivore implicated in a possible rabies exposure should be promptly tested for rabies, and persons possibly exposed through bites from bats and other wildlife should promptly seek medical attention.  Although cases of human rabies in the United States have sharply declined in the last fifty years due to successful animal vaccination campaigns, approximately 40,000 people every year receive vaccination due to potential rabies exposure. Primarily transmitted through the bite of an infected animal, rabies kills nearly 100 percent of all people who contract the virus. Despite its high fatality, rabies is preventable through the timely administration of rabies post exposure prophylaxis (PEP) — a regimen composed of rabies immune globulin and a series of multiple vaccine injections. In the United States, bat exposures are the leading cause of human rabies. In November 2008, a 55 year-old man died from rabies after failing to seek rabies PEP following a bat bite. Low risk perception may have contributed to this unfortunate lapse in rabies prevention.

####

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES