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Volume 16, Number 8—August 2010


Correlation of Pandemic (H1N1) 2009 Viral Load with Disease Severity and Prolonged Viral Shedding in Children

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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 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 If you are not registered on, 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, For technical assistance, contact 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 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.

CME Questions

1. A 10-year-old boy is admitted to the emergency department (ED) with fever, cough, and lethargy of approximately 24 hours' duration. The ED staff recognizes that pandemic (H1N1) 2009 infection has been prevalent in the community, and the mother reports that the child's school recently sent a note home informing parents of several cases in the school. The patient's medical history is significant for asthma, but his mother reports that he has not had wheezing or coughing with this illness and she has not used his rescue medications.

Given this child's age and suspected diagnosis, the clinician should be particularly alert for which of the following potential complications?

  • A. Renal failure

  • B. Pneumonia

  • C. Septicemia

  • D. Bronchitis

    • Which of the following diagnostic tests for pandemic (H1N1) 2009 infection would be most useful to the ED in evaluating this patient?

  • A. DNA polymerase chain reaction (PCR)

  • B. Reverse transcription–PCR (RT-PCR)

  • C. Viral culture

  • D. Viral antibody levels

    • Diagnostic testing confirms pandemic (H1N1) 2009; comorbidities, such as pneumonia and sepsis, are ruled out. Oseltamivir therapy is begun. The patient is monitored in the ED over the next 24 hours, and is now afebrile, alert, and taking fluids. The mother reports that she has a 2-year-old child at home who appears to be well.

What education should be provided to this parent about the patient's contagiousness?

  • A. Viral shedding is reduced by use of oseltamivir and nondetectable within 24 hours

  • B. Viral shedding is higher in children under the age of 13 years, regardless of viral therapy

  • C. Comorbid respiratory illnesses, such as asthma, are associated with prolonged viral shedding

  • D. The patient's infection is not severe, and thus his period of viral shedding will be significantly shorter than average

Activity Evaluation
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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4. The activity was presented objectively and free of commercial bias.
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