Learning Objectives

Emerg Infect Dis

EID

Emerging Infectious Diseases

1080-60401080-6059

Centers for Disease Control and Prevention

2744224

08-1304

10.3201/eid1507.081304

Research

CME ACTIVITY: Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006

72009

15710051011

Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://www.medscape.com/cme/eid; (4) view/print certificate.

Learning Objectives

Upon completion of this activity, participants will be able to:

Describe the transmission of sylvatic epidemic typhus

Specify the most likely exposure to Rickettsia prowazekii among cases in the current series

List common symptoms and signs of sylvatic epidemic typhus

Describe the management of suspected sylvatic epidemic typhus

Editor

P. Lynne Stockton, VMD, MS, Copyeditor, Emerging Infectious Diseases. Disclosure: P. Lynne Stockton, VMD, MS, has disclosed no relevant financial relationships.

CME AUTHOR

Charles P. Vega, MD, Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed that he has served as an advisor or consultant to Novartis, Inc.

AUTHORS

Disclosures: Alice S. Chapman, DVM, MPH; David L. Swerdlow, MD; Virginia M. Dato, MD, MPH; Alicia D. Anderson, DVM, MPH; Claire E. Moodie, MPH; Chandra Marriott, MPH; Brian Amman, PhD; Morgan Hennessey, DVM; Perry Fox, BS; Douglas B. Green, AB; Eric Pegg, DVM; William L. Nicholson, PhD; Marina E. Eremeeva, MD, PhD; and Gregory A. Dasch, PhD, have disclosed no relevant financial relationships.

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to http://www.medscape.com/cme/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.com. If you are not registered on Medscape.com, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

Article Title: Cluster of Sylvatic Epidemic Typhus Cases Associated with Flying Squirrels, 2004–2006CME Questions

Which of the following statements about the transmission of sylvatic epidemic typhus (ST) is most accurate?

A. It is most common in the southern United States

B. It has been established that transmission to humans occurs after arthropod bites

C. It is transmitted only by feces from flying squirrels

D. Contact with flying squirrels or their nests has been confirmed in only a minority of cases

What was the most likely common exposure to Rickettsia prowazekii in the current case series?

A. All case-patients had done extensive cave explorations

B. All case-patients lived in a cabin with flying squirrel nests in the walls

C. All case-patients had led daily nature walks through the surrounding woods

D. All case-patients had performed nature shows involving live animals

Which of the following symptoms and signs of ST was least evident in the current case series?

A. Rash

B. Fever

C. Headache

D. Malaise

Which of the following statements about the management of suspected ST is most accurate?

A. Treatment may begin without laboratory confirmation of infection

B. Serologic confirmation of infection is based on a 10-fold increase in immunoglobulin (Ig) G titers or more

C. IgM antibodies to R prowazekii always decrease rapidly following acute infection

D. PCR analysis for R prowazekii is now widely available

Activity Evaluation

1. The activity supported the learning objectives.
Strongly Disagree				Strongly Agree
1	2	3	4	5
2. The material was organized clearly for learning to occur.
Strongly Disagree				Strongly Agree
1	2	3	4	5
3. The content learned from this activity will impact my practice.
Strongly Disagree				Strongly Agree
1	2	3	4	5
4. The activity was presented objectively and free of commercial bias.
Strongly Disagree				Strongly Agree
1	2	3	4	5