Jacques Pépin, M.D.
Head of Department
E-mail : Jacques.Pepin@USherbrooke.ca
Phone : 819 346-1110, poste 14234
Fax : 819 820-6451
Department of Microbiology and Infectiology
Faculty of Medicine and Health Sciences
Université de Sherbrooke
3001 12th Avenue North
Sherbrooke, Québec J1H 5N4
M.D., Université Laval, Québec (1978)
FRCPC / CSPQ – Infectious Diseases (1988)
M.Sc. in Communicable Disease Epidemiology, London School of Hygiene and Tropical medicine (1998)
Dr. Pepin has been involved in clinic and epidemiological research since 1984 and is primarily interested in T.b. gambiense African human trypanosomiasis(sleeping sickness) and the treatment and epidemiology of this disease. He wrote the chapter on trypanosomiasis in several reference books on tropical diseases and for 3 years chaired a World Health Organization task force on the treatment of this disease; he has also participated in many other WHO consultations as a temporary advisor.
Dr. Pepin has been working on HIV infections in Africa since 1988 and their interaction with sexually transmitted infections (STI), in close collaboration with Dr. Eric Frost, and has explored various aspects of this problem, including HIV-2 infection and its interaction with STIs, the etiology of the most common STI syndromes in Africa, the syndromes associated with Mycoplasma genitalium infection, the epidemiology of HIV in Ghana and Togo, and the syndromic treatment of STIs. For 15 years, these research projects have been combined, with additional funding from CIDA and USAID, with public health interventions aimed at reducing HIV transmission in the Central African Republic, Ghana and Togo.
Since 2002, Dr. Pepin has been conducting epidemiological research on Clostridium difficile colitis, in collaboration with Dr. Louis Valiquette (Université de Sherbrooke) and Dr. Annie-Claude Labbé (Université de Montréal). An initial study documented the dramatic increase in the incidence of C. difficile colitis in the Sherbrooke area and showed that vancomycin was more effective than metronidazole in some patients. A second study aimed at identifying risk factors for C. difficile colitis in patients hospitalized at the CHUS found that fluoroquinolones had become the predominant risk factor for C. difficile colitis. This study earned the Emmanuel Wolinsky award from the Infectious Diseases Society of America for the best article of 2005. Other studies have found an increase in relapse frequency following metronidazole treatment and a one-year mortality of 16.7% for nosocomially acquiredC. difficile colitis cases. In addition, a collaborative study with the CDCs in Atlanta, Health Protection Agency in Great Britiain and a private company in Boston (Acambis) showed that the epidemic strain of C. difficile (NAP1/027) produces 16 to 23 times more toxins than historic strains. An article on reducing the mortality associated with emergency colectomies was published recently, and also a paper describing the impact of reducing antibiotic use on the incidence of C. difficile. Dr. Pepin is a member of an Infectious Diseases Society of America committee of experts that will issue guidelines on C. difficile infection. More recently he expanded his fields of interest in infectiology to include Staphylococcus aureus, Klebsiella pneumoniae andEscherichia coli infections and the epidemiology of hepatitis C.
In the past 4 years, Dr. Pepin has developed an interest in the use of historic data to help understand the emergence of various infectious diseases, including HIV and HCV. In a first study aimed at determining if populations vary in their genetic susceptibility to HIV infection, he used an original approach involving the most extensive natural intermixing of races: the settlement of the Americas. This required obtaining data on the Asian, African and European origins of the populations in each country in the Americas and the intermixing between these various subpopulations. Then using UNAIDS data on the prevalence of HIV in the original populations (in Asia, Africa and Europe), he showed that it is possible to predict quite accurately, based on the origins of these populations, the prevalence of HIV in the populations of countries in the Americas. This supports the hypothesis that genetically determined factors modulate biological susceptibility to HIV infection (in other words, the probability of acquiring HIV during each sexual contact). More recently, in collaboration with Dr. Annie-Claude Labbé, he has shown that medical interventions between 1945 and 1990, and in particular the treatment of African human trypanosomiasis and tuberculosis, contributed greatly to the emergence of HIV-2 in Guinea-Bissau. Phylogenetic analyses of HCV are being done in an attempt to better define the historic evolution of this infection, in collaboration with Dr. Oliver Pybus of Oxford University. In addition, three grants (FRSQ and CIHR) have been obtained for studies aimed at clarifying the role of tropical disease control programs in the emergence of HIV-1 in Equatorial Africa between 1930 and 1960.
For the past 18 years, in addition to supervising medical students, junior residents and senior residents in the infectious diseases program at the CHUS during their clinical rotations, Dr. Pepin has supervised epidemiological research projects in Africa for 7 resident physicians: Dr. Anne-Marie Demers (pediatrics) and Dr. Patrick Morency (community health): respiratory infections in the Central African Republic (CAR); Dr. Marc-Jacques Dubois (internal medicine): urethritis in CAR; Dr. Annie-Claude Labbé (microbiology and infectiology): syphilis in Guinea-Bissau; Dr. Nadine Sauvé (internal medicine): HIV in Ghana; Dr. Anne-Marie Côté (nephrology): epidemiology of HIV and STIs among clients of prostitutes in Ghana; and Dr. Mireille Plamondon: epidemiology of HIV-2 in Guinea-Bissau. In the coming months, Dr. Myriam Lavoie, a senior resident in microbiology and infectiology, will be going to Cameroon for a research internship on hepatitis C.