Karen Wong

• University of Exeter

We detect and interactively visualize occurrence, frequency, sequence, and clustering of extraintestinal manifestations (EIM) and associated immune disorders (AID) in 30,334 inflammatory bowel disease (IBD) patients (Crohn’s disease (CD) n = 15924, ulcerative colitis (UC) n = 11718, IBD unclassified, IBD-U n = 2692, 52% female, median age 40 years...

Background Ustekinumab dose escalation (DE) may be an effective strategy to recapture clinical response in patients with ulcerative colitis (UC). The aim of this study was to assess the real-world long-term effectiveness and safety outcomes following ustekinumab DE in patients with moderate-to-severe UC. Methods This multicenter retrospective coho...

The expanding portfolio of targeted therapies for ulcerative colitis (UC) suggests that a more precise approach to defining disease activity will aid clinical decision-making. This prospective study used genome-wide microarrays to characterize gene expression in biopsies from the most inflamed colon segments from patients with UC and analyzed assoc...

Fecal microbiota transplantation (FMT) is the most effective therapy for preventing recurrent Clostridioides difficile infection (rCDI). However, the impact of FMT formulations and storage conditions on bacterial viability, community structure, functionality, and clinical efficacy remains under-investigated. We studied the effect of different stora...

Digital health tools have the potential to enhance chronic disease management, yet patient adoption remains inconsistent. MyIBDToolkit, a digital platform designed to support individuals with inflammatory bowel disease (IBD), offers self-management resources and communication features to improve patient care. However, understanding patient perspect...

Background Inflammatory bowel disease (IBD) is a chronic condition requiring lifelong management and frequent interactions with healthcare providers. Digital health tools have the potential to enhance disease management by providing real-time data and improving care coordination. Despite their potential, there is limited evidence on patient perspec...

Fecal microbiota transplantation (FMT) is the most effective therapy for preventing recurrent Clostridioides difficile infection (rCDI). However, the impact of FMT formulations and storage conditions on bacterial viability, community structure, functionality, and clinical efficacy remains under-investigated. We studied the effect of different stora...

BACKGROUND Individuals with inflammatory bowel disease (IBD) require comprehensive care to address the physical and psychosocial burden of their disease. The demand for IBD care often exceeds availability, resulting in delayed access and suboptimal management. Self-management tools can help address this gap by empowering patients to be more engaged...

Introduction Fecal microbial transplantation (FMT) has shown promise at inducing remission in ulcerative colitis. This study is the first of its kind to evaluate the efficacy and safety of FMT at inducing remission in Crohn’s disease (CD). Methods This double-blind, placebo-controlled trial was conducted in three Canadian academic centers; randomi...

Background Despite recent emerging literature involving the utility of endoscopic balloon dilation (EBD) of strictures via balloon-assisted endoscopy (BAE), specifically regarding the management of Crohn’s disease (CD), the optimal clinical approach with balloon systems has been largely neglected in academic literature. Objectives This study asses...

Objectives: Describe characteristics of gastroenteritis, bacteremia, and meningitis caused by nontyphoidal Salmonella among US infants. Methods: We analyze national surveillance data during 1968-2015 and active, sentinel surveillance data during 1996-2015 for culture-confirmed Salmonella infections by syndrome, year, serotype, age, and race. Re...

We fit a power law distribution to US foodborne disease outbreaks to assess underdetection and underreporting. We predicted that 788 fewer than expected small outbreaks were identified annually during 1998–2017 and 365 fewer during 2018–2019, after whole-genome sequencing was implemented. Power law can help assess effectiveness of public health int...

SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in the United States during January 2020 (1). Since then, >980,000 cases have been reported in the United States, including >55,000 associated deaths as of April 28, 2020 (2). Detailed data on demographic characteristics, underlying medical conditi...

Introduction Understanding healthcare utilization helps characterize access to healthcare, identify barriers and improve surveillance data interpretation. We describe healthcare-seeking behaviors for common infectious syndromes and identify reasons for seeking care. Methods We conducted a cross-sectional survey among residents in Soweto and Klerks...

Background: Asking people how they would seek healthcare in a hypothetical situation can be an efficient way to estimate healthcare utilization, but it is unclear how intended healthcare use corresponds to actual healthcare use. Methods: We performed a cross-sectional survey between August and September 2012 among households in Soweto and Klerks...

BACKGROUND: Fecal calprotectin (FCP) is a useful biomarker for monitoring inflammatory bowel disease activity, showing good correlation to endoscopic disease activity. The currently used lab tests take 2-4 weeks to return a result, limiting their usefulness. Recently, lateral flow-based rapid tests have been combined with smartphone applications to...

Background From 2004–2015, CDC received 82 reports of patients with Listeria monocytogenes (Lm) cultured from non-sterile sites. Whereas invasive listeriosis (Lm isolated from typically sterile sites) is nationally notifiable and well described, information about patients with “noninvasive” Lm (isolated from other sites) is limited to a small numbe...

Background: The noninvasive biomarkers fecal immunochemical testing (FIT) and fecal calprotectin (FCP) are sensitive for prediction of mucosal inflammation in inflammatory bowel disease. However, neither test has yet been shown to independently and accurately predict mucosal healing (MH). We aimed to assess the specificity of noninvasive FIT and F...

Recommendations for routine use of vaccines in children, ado­lescents and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on use of vaccines and rel...

Background: Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23. While effective in clinical trials for Crohn's disease (CD), long-term maintenance of response in the real-world setting is unclear. We aim to assess the efficacy of ustekinumab for maintaining clinical, endoscopic, and radiographic response in CD. Methods: A retr...

Background and goals: The use of fecal calprotectin (FC) as a stool biomarker for differentiating inflammatory bowel disease (IBD) from IBS has been well validated, and there is a strong correlation between FC and the presence of endoscopic inflammatory lesions. However, recent studies have demonstrated intraindividual sample variability in patien...

We characterized the listeriosis incubation period (IP) among outbreak-associated cases using a simulation model to account for patients with multiple exposure dates. The median IP was 11 days; 90% of cases occurred within 28 days, and the IP varied by clinical manifestation.

Background: Understanding knowledge and sentiment toward influenza and vaccination is important for effective health messages and prevention strategies. We aimed to characterize knowledge, attitudes, and practices surrounding influenza illness and vaccination in two South African communities and explore reasons for vaccine hesitancy. Methods: Ho...

Background. Biologic agents targeting tumor necrosis factor alpha are effective in the management of ulcerative colitis (UC), but their use is often postponed until after failure of other treatment modalities. Objectives. We aim to determine if earlier treatment with infliximab or adalimumab alters clinical and surgical outcomes in UC patients. Met...

Background. Adalimumab is effective for the maintenance of remission in patients with moderate-to-severe ulcerative colitis (UC). Currently, biologic therapies are used in cases where patients fail conventional medical therapies. If biologic therapies are not available, patients often choose to remain in an unwell state rather than undergo colectom...

In the United States, influenza season typically begins in October or November, peaks in February, and tapers off in April. During the winter holiday break, from the end of December to the beginning of January, changes in social mixing patterns, healthcare-seeking behaviors, and surveillance reporting could affect influenza-like illness (ILI) rates...

Last-week ILI rate prediction for HHS region 4. Last-week ILI rate prediction for HHS region 4 was based on previously observed weekly ILI rates and previously fitted last-week ILI rate. A solid blue line represented weekly ILI rates reported by CDC ILInet, a solid red line represented fitted weekly ILI rates. Blue dots and red dots represented the...

Model selection and assumption check. The ARIMA model selection and assumption check for the last-week prediction of 2004 in HHS region 4: a) autocorrelation function indicated a wide range of lagged error terms (q term in ARIMA [p,d,q]); b) partial autocorrelation function indicated the number of auto-regressive terms (p term in ARIMA [p,d,q]) was...

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Bayesian information for the candidate ARIMA models to forecast the 2004 week-52 ILI rate. (DOCX)

ARIMA models and predictions for week 44 to week 8 from influenza season 2004–2005 to 2012–2013. (XLSX)

We describe the first two patients admitted to the Monrovia Medical Unit, a facility established to treat Liberian and international response workers with suspected or known Ebola virus disease (EVD), who illustrate the value of local point-of-care diagnostics, parenteral therapies, and electrolyte replacement in EVD supportive care. Published by O...

The difference between observed and predicted ILI rates during the winter holiday period varies across HHS region and influenza seasons. Most frequently, the last week in December had higher observed than predicted ILI rates, and the first week of January had lower observed than predicted ILI rates.

We describe characteristics of unplanned school closures (USCs) in the United States over two consecutive academic years during a non-pandemic period to provide context for implementation of school closures during a pandemic. From August 1, 2011 through June 30, 2013, daily systematic internet searches were conducted for publicly announced USCs las...

Background & Aims Infliximab is effective for induction and maintenance of response in patients with moderate to moderately-severe ulcerative colitis. Previous cost analyses of infliximab treatment for ulcerative colitis used models of colectomy vs infliximab and response rates derived from early clinical trials. In real life, therapeutic options a...

Background: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can b...

To investigate genetic differences between Crohn's disease (CD) patients with a sustained remission vs relapsers after discontinuing infliximab while in corticosteroid-free remission. Forty-eight CD patients received infliximab and were in full corticosteroid-free clinical remission but then discontinued infliximab for reasons other than a loss of...

Epithelial gaps resulting from intestinal cell extrusions can be visualized with confocal laser endomicroscopy (CLE) during colonoscopy and increased in normal-appearing terminal ileum of inflammatory bowel disease (IBD) patients. Cell-shedding events on CLE were found to be predictive of disease relapse. The aim of this study was to assess the pro...

Background: Epithelial gaps created by shedding of epithelial cells in the small intestine can be visualized by using confocal laser endomicroscopy (CLE). The density of epithelial gaps in the small bowels of patients with inflammatory bowel disease (IBD) and controls without IBD is unknown. Objective: To determine whether the epithelial gap densit...

Epithelial gaps created by shedding of epithelial cells in the small intestine can be visualized by using confocal laser endomicroscopy (CLE). The density of epithelial gaps in the small bowels of patients with inflammatory bowel disease (IBD) and controls without IBD is unknown. To determine whether the epithelial gap density in patients with IBD...

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning inflammatory bowel diseases - specifically, Crohn's disease and ulcerative colitis.

SUMMARY Background Tumour necrosis factor-blockade with infliximab has advanced the treatment of Crohn’s disease. While infliximab is efficacious, it remains to be determined whether patients who enter clinical remission with an antitumour necrosis factor therapy can have their treatment stopped and retain the state of remission. Aim To assess in p...

Cardiac tamponade is a rare extraintestinal manifestation of ulcerative colitis. We present a case report of tamponade occurring four years after curative proctocolectomy and in the absence of any medical therapy for ulcerative colitis. Options for medical management of this condition are also discussed.