Monkeypox Knowledge and Confidence in Diagnosis and Management with Evaluation of Emerging Virus Infection Conspiracies among Health Professionals in Kuwait

Ethical considerations during Mpox Outbreak: a scoping review

BACKGROUND

Historically, epidemics have been accompanied by the concurrent emergence of stigma, prejudice, and xenophobia. This scoping review aimed to describe and map published research targeting ethical values concerning monkeypox (mpox). In addition, it aimed to understand the research gaps related to mpox associated stigma.

METHODS

We comprehensively searched databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Ovid, and Google Scholar) to identify published literature concerning mpox ethical issues and stigma from May 6, 2022, to February 15, 2023. The key search terms used were "monkeypox", "ethics", "morals", "social stigma", "privacy", "confidentiality", "secrecy", "privilege", "egoism", and "metaethics". This scoping review followed the framework proposed by Arksey and O'Malley in 2005 and was further improved by the recommendations of Levac et al. in 2010.

RESULTS

The search strategies employed in the scoping review yielded a total of 454 articles. We analyzed the sources, types, and topics of the retrieved articles/studies. The authors were able to identify 32 studies that met inclusion criteria. Six of the 32 included studies were primary research. The study revealed that the ongoing mpox outbreak is contending with a notable surge in misinformation and societal stigma. It highlights the adverse impacts of stigma and ethical concerns associated with mpox, which can negatively affect people with the disease.

CONCLUSION

The study's findings underscore the imperative need to enhance public awareness; involve civil society; and promote collaboration among policymakers, medical communities, and social media platforms. These collective endeavors are crucial for mitigating stigma, averting human-to-human transmission, tackling racism, and dispelling misconceptions associated with the outbreak.

Assessing healthcare workers' confidence level in diagnosing and managing emerging infectious virus of human mpox in hospitals in Amhara Region, Northwest Ethiopia: multicentre institution-based cross-sectional study

OBJECTIVE

To assess healthcare workers' (HCWs) confidence level in diagnosing and managing mpox disease and its associated factors in hospitals in the Amhara Region.

DESIGN

Institution-based cross-sectional study.

SETTING

Hospitals in the Amhara Region, Northwest Ethiopia.

PARTICIPANTS

A total of 640 HCWs, with a response rate of 96.9%, participated from 1 October to 30 December 2022. A multistage stratified random sampling technique with proportional allocation was used to recruit study participants. Data were collected using the KoboCollect toolbox and exported to STATA V.17 for analysis. Descriptive statistics were used to describe data. Ordinal logistic regression analysis was used to identify predictors of confidence level to diagnose and manage mpox at p<0.05.

PRIMARY OUTCOME

HCWs' confidence level in diagnosing and managing mpox disease and its associated factors.

RESULTS

The overall proportion of HCWs who had high confidence level in diagnosing and managing mpox disease was found to be 31.5% (95% CI: 27.9%, 35.2%). Similarly, 26.8% (95% CI: 23.2%, 30.3%) and 41.8% (95% CI: 38.1%, 45.4%) of HCWs expressed medium and low confidence level to diagnose and manage the disease, respectively. The odds of higher confidence versus lower or medium confidence level in diagnosing and managing mpox were greater for HCWs who regularly visit amenable websites (adjusted OR (AOR)=1.59, 95% CI: 1.16, 2.2), were physicians (AOR=1.9, 95% CI: 1.32, 2.73), were aged 30-35 years old (AOR=1.64, 95% CI: 1.12, 2.39), had got public health emergency epidemic disease management training (AOR=2.8, 95% CI: 1.94, 4.04) and had positive attitudes (AOR=1.72, 95% CI: 1.26, 2.36) compared with their counterparts.

CONCLUSION

The overall confidence level of HCWs in diagnosing and managing mpox disease in the study area was low. Therefore, the HCWs should be regularly updated about mpox disease through morning sessions and training in the diagnosis and clinical management of mpox disease including infection prevention and control.

Transmission dynamics, complications and mitigation strategies of the current mpox outbreak: A comprehensive review with bibliometric study

As the mankind counters the ongoing COVID-19 pandemic by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it simultaneously witnesses the emergence of mpox virus (MPXV) that signals at global spread and could potentially lead to another pandemic. Although MPXV has existed for more than 50 years now with most of the human cases being reported from the endemic West and Central African regions, the disease is recently being reported in non-endemic regions too that affect more than 50 countries. Controlling the spread of MPXV is important due to its potential danger of a global spread, causing severe morbidity and mortality. The article highlights the transmission dynamics, zoonosis potential, complication and mitigation strategies for MPXV infection, and concludes with suggested 'one health' approach for better management, control and prevention. Bibliometric analyses of the data extend the understanding and provide leads on the research trends, the global spread, and the need to revamp the critical research and healthcare interventions. Globally published mpox-related literature does not align well with endemic areas/regions of occurrence which should ideally have been the scenario. Such demographic and geographic gaps between the location of the research work and the endemic epicentres of the disease need to be bridged for greater and effective translation of the research outputs to pubic healthcare systems, it is suggested.

Assessment of Monkeypox (MPOX) Knowledge and Vaccination Intention among Health and Life Sciences Students in Algeria: A Cross-Sectional Study

Monkeypox (MPOX) is a viral zoonotic disease affecting endemically the Central and Western regions of Africa. The ongoing outbreak in non-endemic countries has made this disease a global concern. While no cases have been reported in Algeria, it is important to raise awareness about the disease to prepare for a potential outbreak, especially in light of the cases reported in neighboring Middle East and North African (MENA) countries. This study aimed to evaluate the knowledge and attitude of Algerian Health and Life Sciences students toward MPOX and its vaccine through an anonymous online survey. A total of 196 students participated in this study. Students of medicine (64.3%), females (85.7%), and those under 20 years of age (55.1%) were the most represented. The results revealed a low level of knowledge represented by a score of only 42.8% for correct answers with multiple gaps in epidemiology, etiology, and clinical manifestations of MPOX. Students of veterinary sciences showed the highest levels of knowledge (OR: 6.71; CI95%: 1.23-36.77), while those aged between 20 and 30 years old (OR: 0.11; CI95%: 0.02-0.79) and those vaccinated against seasonal flu (OR: 0.42; CI95%: 0.21-0.85) were associated with low levels of knowledge. Regarding MPOX vaccination, the study found a moderate level of acceptance (48.5%) among the surveyed students with Natural and Life Sciences students and those having a high vaccine conspiracy belief score (VCBS) showing the lowest level of acceptance. These findings highlight the need for educational programs and intensified public awareness campaigns to improve knowledge about MPOX and emphasize the importance of vaccination in preventing outbreaks and overcoming vaccine reluctance.

Knowledge of the monkeypox 2022 outbreak among dental hygienists and students in Saudi Arabia: A cross-sectional study

OBJECTIVE

This study aimed to assess the knowledge of monkeypox infection among dental hygiene professionals and students in Saudi Arabia.

METHODS

A cross-sectional study was conducted among a convenience sample of dental hygiene professionals (n = 259). The questionnaire was developed based on previous literature, and descriptive analysis and a Chi-square test were performed.

RESULTS

A total of 159 dental hygienists responded to the questionnaire. Results indicated that only 1.7% had good knowledge, 7.7% had moderate knowledge and 90.6% had low knowledge of the monkeypox outbreak. The mean knowledge scores varied among dental hygiene students, practitioners and faculty members. Significant group differences were observed for some questions (p < 0.05).

CONCLUSION

Our study concludes that dental hygienists had moderate to low level of knowledge of the monkeypox infection and its implications for oral health and patient care, indicating a need for more education on the subject.

Knowledge of the Mpox virus and conspiracy beliefs and their association with self-confidence in managing the virus among Israeli orthopedic surgeons

In 2022, the Mpox viral outbreak signaled a global public health emergency. Infectious disease management and prevention are crucial tasks for healthcare workers. In their line of work, orthopedic surgeons could come across cases of the Mpox virus. The aim of the present study was to explore orthopedic surgeons' knowledge of the Mpox virus, their conspiracy beliefs regarding emerging viral infections, and their self-confidence in managing the Mpox virus. In this cross-sectional survey, 137 orthopedic surgeons completed an online questionnaire. The participants had low knowledge of the Mpox virus, providing on average 11.5 correct answers (SD = 2.68) of a possible 21. In addition, the participants tended to express moderate conspiracy beliefs and to have low self-confidence in managing the Mpox virus. Age 30 or older, a higher knowledge level, and lower conspiracy beliefs predicted greater self-confidence in managing the Mpox virus. In addition, a negative association was found between knowledge of the Mpox virus and conspiracy beliefs. Arab and younger orthopedic surgeons expressed stronger conspiracy beliefs. Interventions should include introduction of material regarding emerging tropical infections in medical curricula and in-service training programs. In addition, special attention should be paid to younger and Arab orthopedic surgeons, as these subgroups may endorse higher conspiracy beliefs.

Perceptions and Knowledge of Public Towards Emerging Human Monkeypox in Yemen: A Cross-Sectional Study

Background

The spread of monkeypox (mpox) worldwide poses a severe threat to human life. This virus leads to a disease with symptoms similar to smallpox in humans. To combat this threat, improving public knowledge and perception toward mpox is vital for public health preventive measures.

Methods

A cross-sectional survey was carried out in Yemen from December 2022 to March 2023 to investigate public perception and knowledge of mpox. Individuals were approached through social media platforms using a convenient sampling approach. Linear regression was used to determine the association between participants' knowledge (dependent variable) and explanatory variables.

Results

A total of 853 individuals consented to take part in the study. A significant proportion of respondents had a low knowledge level (N=572, 67.06%). Most participants knew about the nature of the diseases (75%, n=641), transmission mode (78.1%, n=668), hand sanitizer preventive measures, and skin- related symptoms. However, only 20.8% (n= 178) knew that diarrhea is not a symptom, and 25.4% (n= 217) knew antibiotics are unnecessary for mpox management. A proportion of 57.7% (n=492) of the participants feared human mpox, and 47.7% (n= 407) thought it was a conspiracy. Most participants had a good perception of local and international health authorities controlling the disease. Age, education level, having a health-related certificate, and receiving a 2-dose vaccination for COVID-19 had statistically significant associations with mpox knowledge level (P < 0.05). Social media platforms were the most often used information source about mpox (78.3%, n= 668), followed by articles (41.1%, n=351).

Conclusion

The study reveals a low public knowledge about mpox in Yemen, emphasizing the need for targeted educational campaigns, especially via social media, to strengthen public health measures and disease control. Addressing Knowledge gaps and correcting misconceptions is crucial for improving preparedness and response to the disease.

Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study

Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.

The preparedness and knowledge of pharmacists and general practitioners in managing human monkeypox: a highly spreading infectious disease

BACKGROUND

After the era of the COVID-19 pandemic, the role of pharmacists was emphasized in the battle against highly spreading and infectious diseases like human Monkeypox (hMPV).

AIM

Assess the hMPV knowledge of the community, clinical pharmacists, and general practitioners (GPs) and raise their awareness about hMPV.

METHODS

A web-based questionnaire was distributed randomly to Egyptian community pharmacists, clinical pharmacists, and GPs from all governorates. The questionnaire was divided into two sections: one for demographic information and the other for hMPV knowledge (nature of the disease, incubation period, transmission, symptoms, Prophylaxis, Prevention, and management). The evidence-based answers were provided after completing the submission. Data were descriptively analyzed using IBM SPSS software.

RESULTS

From a total of 753 respondents, only 710 participants were included in the final data analysis. The % of respondents who presented good total knowledge scores about hMPV was comparable between study groups (P = 0.826). There were no differences between groups identifying different disease clinical characteristics (P = 0.689) and hMPV management (P = 0.324). Community pharmacists had better knowledge scores than GPs in the prevention and prophylaxis domain (P = 0.037).

CONCLUSION

Pharmacists and GPs have good and similar knowledge levels of hMPV. However, a gap exists in recognizing the right hMPV incubation period, prophylaxis, and omitting antibiotics from hMPV management. Pharmacists and GPs are the frontline health care providers (HCPs), so they would require more knowledge enhancement about such contagious diseases to offer the best possible patient care.

Evaluation of human monkeypox knowledge and beliefs regarding emerging viral infections among healthcare workers

OBJECTIVES

The purpose of this study was to evaluate possible factors that might be accompanied by high level of human monkey pox (HMPX) knowledge and to explain the relationship between HMPX knowledge and Beliefs regarding emerging viral infections.

STUDY DESIGN

A descriptive cross-sectional study was conducted for the implementation of this study.

METHODS

Study was conducted at two general hospitals in Mansoura City (Old General Hospital and International Hospital) El Dakahlia Governorate among 620 healthcare workers (HCWs) using a self-managed questionnaire for 1 week (1 to 7 January 2023). The questionnaire has items adapted from the previously published literature to assess HMPX knowledge and Beliefs regarding emerging viral infections.

RESULTS

The mean age of the study sample was 27.97 years and most of them were female (86.1%). Physicians and other HCWs (nurses, laboratory technicians, radiographer technicians, and pharmacists) had significantly different levels of knowledge of monkeypox for the majority of the questions. A higher belief was found among two items: viruses are biological weapons manufactured by the superpowers to take global control and the government is misleading the public about the cause of the virus.

CONCLUSION

This study discovered lower levels of knowledge of HMPX among HCWs in Egypt. Beliefs about emerging viral infections were widespread, and future research should look into their potential negative impact on health behavior.

Knowledge, attitude, and practice of university students towards monkeypox in Bangladesh

The recent outbreak of viral zoonotic disease-monkeypox-caused by the monkeypox virus, has infected many people worldwide. This study aims to explore the knowledge, attitudes, and practices (KAP) concerning monkeypox among university students in Bangladesh. Data were collected using purposive snowball sampling from 887 university students through an online survey using Google Form. The participants were mostly in their twenties (M = 22.33 [SD 2.01] years), and they spent, on average, 2.59 [SD 1.91] hours/day on electronic and social media. The participants generally showed moderate knowledge (39.5%), low attitude (25.1%), and moderate practice (48.6%) toward monkeypox, with 47.6% having had a moderate KAP score. Findings further showed that personal attributes of university students, i.e., age, sex, year of schooling, residence, living status, geographical distribution, e.g., division, were statistically and significantly associated with knowledge, attitudes, and practices regarding monkeypox and overall KAP score. It is also apparent that health status, susceptibility to monkeypox, and exposure to social media were the most common factors significantly associated with knowledge, attitudes, and practices regarding monkeypox and overall KAP score. The current study's findings underscore the need for developing appropriate information, education, and communication (IEC) materials and their dissemination, which could play an important role in reducing the risk of monkeypox and similar other infectious diseases, particularly among students in Bangladesh.

Belarusian Healthcare Professionals' Views on Monkeypox and Vaccine Hesitancy

BACKGROUND

Despite the low transmission risk of Monkeypox (mpox) in Belarus, this study is vital as it contributes to our understanding of vaccine hesitancy among healthcare professionals (HCPs). It aims to assess vaccination perceptions and evaluate the willingness to pay for the vaccine among Belarusian HCPs, thereby enhancing pandemic preparedness.

METHODS

in October 2022, a cross-sectional survey-based study was conducted among Belarusian HCPs using a self-administered questionnaire (SAQ). Invitations were disseminated via social media platforms using a snowball sampling method. The SAQ encompassed various categories, including sociodemographic details, medical history, sources of mpox information, perceived and factual mpox knowledge, and perceptions of the mpox vaccine according to the health belief model (HBM), mpox vaccine acceptance and willingness to pay (WTP).

RESULTS

while a large proportion of respondents had good knowledge of mpox epidemiology and its clinical manifestations, their awareness of available vaccines and treatment options was limited. Consequently, a significant correlation was found between the history of influenza vaccination and mpox-related knowledge. Furthermore, the study showed that just over half of the participants (51.4%) were willing to receive the mpox vaccine if offered for free, safely, and effectively, with their decision largely influenced by perceived benefits (Spearman's rho = 0.451) and cues to action (Spearman's rho = 0.349). However, a considerable degree of hesitancy (30.6%) and resistance (18.1%) towards the mpox vaccine was observed, underscoring the need for targeted interventions to address these issues.

CONCLUSIONS

this study highlights a significant knowledge gap among Belarusian HCPs about mpox vaccines and treatments, despite a general awareness of the disease's epidemiology and symptoms, and it underscores the need for targeted interventions to enhance mpox knowledge and vaccine acceptance.

Assessing disparities in medical students' knowledge and attitude about monkeypox: a cross-sectional study of 27 countries across three continents

Background and aims

The recent monkeypox (Mpox) outbreak confirmed by the World Health Organization (WHO) underscores the importance of evaluating the knowledge and attitude of medical students toward emerging diseases, given their potential roles as healthcare professionals and sources of public information during outbreaks. This study aimed to assess medical students' knowledge and attitude about Mpox and to identify factors affecting their level of knowledge and attitude in low-income and high-income countries.

Methods

A cross-sectional study was conducted on 11,919 medical students from 27 countries. A newly-developed validated questionnaire was used to collect data on knowledge (14 items), attitude (12 items), and baseline criteria. The relationship between a range of factors with knowledge and attitude was studied using univariate and multivariate analyses.

Results

46% of the study participants were males; 10.7% were in their sixth year; 54.6% knew about smallpox; 84% received the coronavirus disease 2019 (COVID-19) vaccine; and 12.5% had training on Mpox. 55.3% had good knowledge of Mpox and 51.7% had a positive attitude towards it. Medical students in their third, fifth, or sixth year high- income countries who obtained information on Mpox from friends, research articles, social media and scientific websites were positive predictors for good knowledge. Conversely, being male or coming from high-income countries showed a negative relation with good knowledge about Mpox. Additionally, a positive attitude was directly influenced by residing in urban areas, being in the fifth year of medical education, having knowledge about smallpox and a history of receiving the coronavirus disease 2019 (COVID-19) vaccine. Receiving information about Mpox from social media or scientific websites and possessing good knowledge about Mpox were also predictors of a positive attitude. On the other hand, being male, employed, or receiving a training program about Mpox were inversely predicting positive attitude about Mpox.

Conclusion

There were differences in knowledge and attitude towards Mpox between medical students in low and high-income countries, emphasizing the need for incorporating epidemiology of re-emerging diseases like Mpox into the medical curriculum to improve disease prevention and control.

From Conspiracy to Hesitancy: The Longitudinal Impact of COVID-19 Vaccine Conspiracy Theories on Perceived Vaccine Effectiveness

The embrace of coronavirus disease 2019 (COVID-19) vaccine conspiracies has been linked to vaccine hesitancy. This study aimed to investigate the relationship between COVID-19 vaccine conspiracy theories and perceived vaccine effectiveness. The study utilized a longitudinal follow-up study in which adults in Chile completed surveys in December 2020 (T1) and May 2021 (T2). The psychometric properties of the five-item instrument on conspiracy theories for the COVID-19 vaccine were evaluated using data from T1 (n = 578). A confirmatory one-factor structure with suitable indicators of reliability was found. The longitudinal analysis (n = 292) revealed that conspiracy theories about the COVID-19 vaccine in T1 were associated with lower beliefs in its effectiveness in T2. However, no significant association was found between beliefs in effectiveness in T1 and conspiracy theories in T2. The study suggests that beliefs in conspiracy theories may temporally precede beliefs in vaccine effectiveness for COVID-19. The results have implications for strategies to address vaccine conspiracy beliefs and their implementation at the public policy level.

Monkeypox in Syria: Highlighting an awareness issue

Background

The World Health Organization (WHO) verified 780 cases of monkeypox across 27 countries between 13 May 2022 and 2 June 2022. The aim of our study was to assess the level of awareness of human monkeypox virus among Syrian medical students, general practitioners, medical residents, and specialists.

Methods

A cross-sectional online survey was performed in Syria between May 2 and September 8, 2022. The survey consisted of 53 questions within the following three categories: demographic information, work-related details, and monkeypox knowledge.

Results

In total, 1257 Syrian healthcare workers and medical students were enrolled in our study. The animal host and incubation time for monkeypox were correctly identified by just 2.7% and 33.3% of responders, respectively. Sixty percent of the study sample thought that the symptoms of monkeypox and smallpox are identical. No statistically significant associations were found between predictor variables and knowledge regarding monkeypox (p-value > 0.05).

Conclusion

Education and awareness regarding monkeypox vaccinations are of paramount importance. It is essential that clinical doctors are adequately aware of this disease, in order to avoid an uncontrolled situation, as experienced with COVID-19.

Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination

During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.

Knowledge of Community Pharmacists in Saudi Arabia Regarding Human Monkeypox, Its Management, Prevention, and Vaccination: Findings and Implications

Many cases of monkeypox have recently been reported in countries where this disease is not endemic, raising a global health concern. Consequently, healthcare professionals (HCPs), including pharmacists, need to be aware of the disease, its prevention, including the role of vaccines, and its management to reduce transmission. A cross-sectional, questionnaire-based study was conducted among conveniently sampled community pharmacists in the Qassim region of Saudi Arabia. A total of 189 community pharmacists participated in the study, giving a response rate of 72.97%. From these, 86.77% were male, 51.32% were ≤30 years old, 36.51% were aged between 31-40 years, and 43.39% had 1-5 years of experience as community pharmacists. Their overall knowledge was 17.72 ± 5.56 out of a maximum of 28. The overall rate of correct answers for the knowledge statements was 63.29%, with 52.4% answering ≥50-<75% of the knowledge questions correctly and 31.2% answering ≥75% of the questions correctly. The knowledge subdomain related to diagnosis and clinical characteristics recorded the highest score, with the subdomain relating to causative pathogens and epidemiology recording a lower score. Overall, community pharmacists had moderate knowledge of monkeypox and its clinical management, prevention, and the role of vaccines, which is a concern for the future. Consequently, tailored, flexible, and timely educational interventions are needed to ensure that HCPs, including community pharmacists, are fully equipped with the latest evidence-based knowledge regarding this viral disease to reduce transmission and improve care.

Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs

A substantial burden of high-risk human papillomavirus (HPV) infections and HPV-related cancers can be mitigated by vaccination. The current study aimed to investigate the willingness of female students at the University of Kuwait to get HPV vaccination and its possible association with general vaccine conspiracy beliefs (VCBs). This cross-sectional survey study was conducted during September-November 2022 using a validated VCB scale as the survey instrument. The final sample comprised 611 respondents with a median age of 22 y and a majority of Arab ethnicity (n = 600, 98.2%). Only 360 respondents (56.9%) heard of HPV before participation and these students showed an above-average level of HPV knowledge (mean knowledge score of 12.7 ± 2.6 out of 16 as the maximum score), of whom only 33 self-reported HPV vaccine uptake (9.2%). The willingness to accept free-of-charge HPV vaccination was seen among 69.8% of the participants, with 20.1% who were hesitant and 10.1% who were resistant. The acceptance of HPV vaccination if payment is required was 23.1%. Reasons for HPV vaccine hesitancy/resistance included complacency to the HPV disease risks, lack of confidence in HPV vaccination, and inconvenience. The embrace of VCBs was associated with significantly higher odds of HPV vaccine hesitancy/resistance. The current study showed the detrimental impact of endorsing vaccine conspiracy beliefs manifested in lower intention to get HPV vaccination among female university students in Kuwait. This should be considered in vaccine promotion efforts aiming to reduce the burden of HPV cancers.

Knowledge and awareness of Algerian healthcare workers about human monkeypox and their attitude toward its vaccination: An online cross-sectional survey

Objectives

This study was carried out to assess the level of knowledge of Algerian healthcare workers about human monkeypox, and their attitude toward its vaccination.

Methods

An online-based cross-sectional study using social media platforms targeting Algerian healthcare workers was conducted between 28 June and 18 September 2022.

Results

111 healthcare workers have answered the questionnaire. Overall, a medium level of knowledge (64.9%) was obtained with multiple gaps about the epidemiology and clinical features of this disease. Factors associated with high levels of knowledge included young age, being married and practicing outside the province town. Also, only 38.7% of the respondents were in favor of human monkeypox vaccination if recommended for free with COVID-19 vaccine uptake as a determinant factor of acceptance.

Conclusion

Results have shown a medium level of knowledge and a low rate of vaccination willingness. The findings of this study although not representative of all Algerian healthcare workers, could be a baseline for human monkeypox knowledge and vaccination in Algeria.

Knowledge, Attitude and Worry in the Kurdistan Region of Iraq during the Mpox (Monkeypox) Outbreak in 2022: An Online Cross-Sectional Study

The rapid spread of monkeypox (mpox) has been declared as a public health emergency of international concern (PHEIC). The present study aimed to assess the knowledge, attitude, and worry levels of the general population in the Kurdistan region of Iraq regarding the ongoing mpox multi-country outbreak. An online cross-sectional survey was conducted between 27–30 July 2022, using a convenience sampling method. The questionnaire was adapted from previous studies addressing the same topic. The independent Student’s t-test, one-way ANOVA, and logistic regression were used to assess possible factors associated with knowledge, attitude, and worry toward mpox. A total of 510 respondents were included in the final analysis. The participants showed a moderate level of mpox knowledge, a neutral attitude towards mpox, and a relatively moderate worry level. The logistic regression analysis showed that age, gender, marital status, religion, level of education, and place of residence were associated with mpox knowledge; however, the significant variables in the multivariate regression analysis were gender, religion, level of education, and residential area. Gender and residential area were associated with attitudes toward mpox; however, the significant variables in the multivariate regression analysis were gender and residential areas. The worry toward mpox was influenced by gender, marital status, religion, and place of residence, yet the significant variables in the multivariate regression analysis were gender, religion, educational level, and residential area. In conclusion, the Kurdish population had moderate knowledge, a neutral attitude, and a moderate level of worry about mpox. Considering the continuous rapid rise in mpox cases in several countries, and its possible risk as pandemic amid the ongoing COVID-19 pandemic, proactive control measures, adequate disease prevention strategies, and preparedness plans need to be formulated and immediately implemented to tackle the appearance of fears among people, and to safeguard the mental health of the public.

Molecular docking of monkeypox (mpox) virus proteinase with FDA approved lead molecules

BACKGROUND

Monkeypox virus (mpox) disease is caused by a double-stranded DNA virus from the Poxviridae family. The mpox virus showed structural similarity with smallpox virus disease. The recent outbreak of mpox infection in the rest of African countries causes public health issues of increased pandemic potential. Mpox virus is involved in the viral replication cycle through the biocatalytic reaction of precursor polyproteins cleavage.

OBJECTIVES

The main objective of the study was to analyze the molecular interactions between mpox and FDA-approved drugs.

METHODS

The primary and secondary structure of the protein was retrieved and FDA approved drug was screened using AutoDock. The best hit was analyzed and the molecular interactions were studied. Model validation analyzes the peptide, energy of hydrogen bonds, steric conflicts and bond planarity. Z-score was calculated using ProSA-web tool and the score tested the native fold from other alternative folds.

RESULTS

The confidence level of the submitted amino acids was> 80 % and the maximum confidence score for a single template was 98.2 %. The generated proteinase model was subjected to analyze the distribution of atoms and the using ERRAT server. The overall quality score was 88.535 and this value represents the amino acid percentage with anticipated error value and the value falling below the rejection limit. The Z-score of this study result was within the Z-score range (-4.17) validated for native enzymes. The binding pockets of the enzyme were determined in this study and two binding pockets were predicted using the automatic online tool using the web server. The selected FDA-approved drugs were ordered based on their minimum binding energy to the proteinase.

CONCLUSIONS

Molecular docking studies revealed the involvement of various hydrophobic interactions between FDA-approved drugs and amino acid residues of monkeypox virus proteinase.

Mpox Perceptions and Vaccine Advocacy among the Healthcare Workers of Solid Organ Transplant Centers: A Multicenter, Cross-Sectional Survey in Saudi Arabia

BACKGROUND

In response to the global Mpox outbreaks, this survey aimed to assess the knowledge, perceptions, and advocacy of Mpox vaccines among solid organ transplant healthcare workers (HCWs) in Saudi Arabia.

METHODS

A cross-sectional survey was conducted among solid organ transplant HCWs in Saudi Arabia from 15 August to 5 September 2022. A total of 199 responses were received from participants primarily working in the kidney (54.8%) and liver (14.6%) transplant units.

RESULTS

The survey found that most participants were aware of the 2022 Mpox outbreak, but the majority were more concerned about COVID-19 than Mpox. While the majority of participants thought laboratory personnel and HCWs in direct contact with Mpox patients should receive the vaccine, less than 60% believed that all HCWs should be vaccinated. Additionally, over half of the participants lacked knowledge of animal-human transmission of the virus.

CONCLUSION

The results highlight the need for increased education on Mpox among transplant HCWs in Saudi Arabia, particularly regarding the virus's transmission dynamics and vaccines. This education is crucial to improve HCWs' understanding of this emerging disease, especially given their vulnerability during the COVID-19 pandemic.

Knowledge, Attitude and Conspiracy Beliefs of Healthcare Workers in Lebanon towards Monkeypox

The emergence of a monkeypox (MPOX) outbreak in 2022 represented the most recent recognizable public health emergency at a global level. Improving knowledge and attitude towards MPOX, particularly among healthcare workers (HCWs), can be a valuable approach in public health preventive efforts aiming to halt MPOX virus spread. The aim of the current study was to evaluate the knowledge and attitude of HCWs in Lebanon towards MPOX and to assess their conspiratorial attitude towards emerging virus infections (EVIs). The current study was based on a cross-sectional online survey distributed via Google Forms during September-December 2022 implementing a convenience sampling approach. The final study sample comprised a total of 646 HCWs: physicians (n = 171, 26.5%), pharmacists (n = 283, 43.8%), and nurses (n = 168, 26.0%), among others (n = 24, 3.7%). Variable defects in MPOX knowledge were detected, with a third of the participants having MPOX knowledge above the 75th percentile (n = 218, 33.7%). Satisfactory attitude towards MPOX (>75th percentile) was observed in less than a third of the participants (n = 198, 30.7%), while a quarter of the study sample endorsed conspiracy beliefs towards EVIs at a high level (>75th percentile, n = 164, 25.4%). Slightly more than two thirds of the participants agreed that MPOX vaccination should be used in disease prevention (n = 440, 68.1%). Better levels of MPOX knowledge and attitude were significantly associated with postgraduate education and older age. Physicians had significantly higher MPOX knowledge compared to other occupational categories. Less endorsement of conspiracies towards EVIs was significantly associated with male sex, occupation as a physician, and postgraduate education. Higher MPOX knowledge was associated with better attitude towards the disease. The current study showed unsatisfactory MPOX knowledge among Lebanese HCWs. Educational efforts can be valuable to improve the attitude towards the disease. Despite the relatively low level of embracing conspiracy beliefs regarding EVIs among HCWs in this study compared to previous studies, this area should be considered based on its potential impact on health-seeking behavior.

Monkeypox (MPOX)-Related Knowledge and Vaccination Hesitancy in Non-Endemic Countries: Concise Literature Review

In May 2022, the world witnessed the emergence of human monkeypox (MPOX), a new zoonotic viral disease in multiple non-endemic countries. This health threat has been associated with increased anxiety, especially after the COVID-19 catastrophe. In addition, people are exposed to an unprecedented amount of information, making them vulnerable to misinformation that may lead to embracing conspiracy theories. This literature review was conducted to evaluate the levels of MPOX-related knowledge and attitudes toward its vaccination by reviewing studies indexed in MEDLINE^® until 15 November 2022. A total of 16 studies conducted in non-endemic countries were included in this review, predominantly in Europe, the Middle East, and Asia. Nine studies investigated exclusively MPOX-related knowledge and awareness, and two studies were exclusively related to MPOX vaccines, while five studies dealt with both topics. The target populations were mainly healthcare professionals and the general adult population. The results revealed an unsatisfactory level of knowledge and awareness among certain groups. Regarding vaccination, the results showed that vaccine hesitancy is still common for healthcare professionals except among Chinese healthcare professionals, where the rate of vaccine acceptance was estimated at 90.1%. This review could help understand the MPOX-related knowledge and awareness and vaccine hesitancy in the first months of the emergence of the MPOX by comparing their evolution in recent studies.

Level of Knowledge Regarding Mpox among Peruvian Physicians during the 2022 Outbreak: A Cross-Sectional Study

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox.

The willingness of Chinese healthcare workers to receive monkeypox vaccine and its independent predictors: A cross-sectional survey

The global monkeypox outbreak in 2022 has severely affected the life and health of people. Currently, partial smallpox vaccines have been approved for monkeypox prevention. Considering the potential occupational health risks of monkeypox infection among healthcare workers (HCWs), this study explored the willingness of Chinese HCWs to receive the monkeypox vaccine and analyzed the factors influencing their decision. We conducted an online cross-sectional survey among HCWs of 10 Chinese hospitals from May 30th, 2022 to August 1st, 2022. Specifically, a self-report questionnaire was administered to evaluate the attitude and acceptance of HCWs toward the monkeypox vaccine, followed by a multivariate logistic regression analysis to determine the independent predictors of vaccination. The survey included 1032 participants, of whom 90.12% expressed their willingness for vaccination (vaccine hesitancy rate = 9.88%). Univariate analysis showed that 11 variables differed significantly between the vaccine acceptance and vaccine hesitancy groups. Multivariate logistic regression analysis demonstrated that the age of 30-40 years (odds ratio [OR] = 0.504, 95% confidence interval [CI]: 0.284-0.893, p = 0.019 vs. age of <30 years old), working in a secondary hospital (OR = 0.449, 95% CI: 0.249-0.808, p = 0.019 vs. working in a tertiary hospital), considering vaccination necessary for controlling monkeypox infection (OR = 4.135, 95% CI: 2.109-8.106, p < 0.001 vs. not considering it necessary), willingness to pay for the monkeypox vaccine (OR = 2.125, 95% CI: 1.206-3.745, p = 0.009 vs. no willingness to pay), considering implementation of mandatory vaccination necessary (OR = 1.990, 95% CI: 1.023-3.869, p = 0.043 vs. not considering it necessary), and recommending family members and friends to take the vaccine (OR = 13.847, 95% CI: 7.487-25.609, p < 0.001 vs. not recommending) were crucial independent predictors of the willingness to receive monkeypox-related vaccination. This study evaluated the acceptance and hesitancy rates of Chinese HCWs toward the monkeypox vaccine and found that the willingness to receive vaccination was mainly correlated to age, hospital level, and attitude toward vaccination. Therefore, to promote vaccine absorption, we recommend expanding publicity, formulating reasonable policies, and improving the recognition of vaccines.

Knowledge and attitudes of health care workers about monkeypox virus infection in Southern Italy

Background

This present survey sought to investigate the level of knowledge and the attitudes pertaining the monkeypox (mpox) virus infection among a sample of health care workers (HCWs) in Italy, as well as the possible role of different factors on these outcomes.

Methods

The cross-sectional survey was performed from July through October, 2022 at four randomly selected hospitals located in Southern Italy.

Results

The questionnaire was completed by 421 HCWs, for an overall 59% response rate. Less than two-thirds were able to define the disease and the correct answer of the transmission mechanisms ranged from 22.8% for contact with contaminated objects to 75.8% through close contact with body fluids. Only 4% and 12.8% indicated HCWs and elderly/frail/people with underlying immune deficiencies as risk groups. The mean overall score of the knowledge assessment on mpox was 3.4 (0-9). The multivariate logistic regression analysis showed that HCWs with a lower number of years of working experience and those who had acquired information about mpox from scientific journals were more likely to have a higher level of knowledge. The average score of the perception of the severity of the disease was 6.3. A similar score with a value of 6.1 has been observed for the statement that mpox is a serious problem for the population. Regarding the level of concern about contracting mpox, the mean score was 5.1. Only 10.5% reported that they feel that this disease can be prevented, with an overall mean score of 6.5. Almost all HCWs reported that they are still living as usual, with no modification of their behavior for fear of contracting the mpox. The results of the multivariate logistic regression model showed that women, HCWs with a higher level of knowledge about mpox, and those who needed additional information about mpox were more likely to have a higher level of perception of the severity of the disease.

Conclusion

This survey has demonstrated that HCWs had an unsatisfactory level of knowledge toward mpox and only nearly half showed positive attitudes. Strategic health training programs should be made so that knowledge can be acquired.

Monkeypox Cross-Sectional Survey of Knowledge, Attitudes, Practices, and Willingness to Vaccinate among University Students in Pakistan

This study aimed to explore knowledge, attitude, perceptions, and willingness regarding vaccination among university students in Pakistan. This cross-sectional study was carried out using an open online self-administered survey via Google Forms. The survey data were collected between the 15 to 30 of October 2022. A total of 946 respondents participated in the study, of which the majority were female (514, 54.3%). Most students belonged to a medical background, specifically pharmaceutical sciences. Most of the respondents did not know about monkeypox before 2022 (646, 68.3%). Regarding overall knowledge of monkeypox, most of the respondents had average knowledge (726, 76.7%), with very few having good knowledge (60, 6.3%). Regarding overall attitudes towards monkeypox, most of the respondents had neutral attitudes (648, 68.5%). There was a significant association between knowledge of Monkeypox with the type of academic degree (p < 0.001), type of discipline (p < 0.001), and region of respondents (p < 0.001). The willingness to vaccinate among the population was (67.7%). The current study pointed out that the overall knowledge of monkeypox was average in most respondents, with considerable knowledge gaps in most aspects. The overall attitude towards monkeypox was neutral. Further, the knowledge about monkeypox was strongly associated with academic degree, study discipline, and region of respondents. Our findings emphasize the need to raise public awareness by educating students on the monkeypox virus. This will improve adherence to preventative recommendations.

Knowledge and vaccination intention of monkeypox in China's general population: A cross-sectional online survey

BACKGROUND

Public awareness of monkeypox is critical in the fight against this infectious disease. However, at present a survey of the Chinese population on monkeypox is lacking. This study was conducted to compensate for the lack of knowledge and identify a vaccination intention assessment for monkeypox in China.

METHODS

The questionnaire comprised 20 items with the following three aspects: basic information, knowledge, and willingness to vaccinate or pay. For this study, 521 valid respondents were recruited. Utilizing logistic regression, the researchers identified the factors related with knowledge and vaccination intentions.

RESULTS

The average total score for knowledge of monkeypox was 5.6 (score range 0-10), and 309 (59.3%) participants were categorized as having greater knowledge based on a total score of 6. Most participants (76.4%) were willing to accept a monkeypox vaccination. The average acceptable cost of the monkeypox vaccine was CNY261.2. Factors such as level of education, and working within the healthcare profession were related to monkeypox knowledge. An increased knowledge of monkeypox was related to a higher willingness to vaccinate. Participants who were willing to pay more for vaccines included those with high incomes, who suffered from chronic diseases, and healthcare workers.

CONCLUSIONS

The Chinese population had relatively high knowledge of monkeypox and demonstrated a willingness to receive the vaccine.

Psychological Antecedents of Healthcare Workers towards Monkeypox Vaccination in Nigeria

The ongoing monkeypox (MPX) outbreak has been declared a public health emergency of international concern. People in close contact with active MPX cases, including healthcare workers (HCWs), are at higher risk of virus acquisition since the MPX virus can be transmitted by skin contact or respiratory secretions. In this study, we aimed to assess the psychological antecedents of MPX vaccination among Nigerian HCWs using the 5C scale. We used an anonymous online cross-sectional survey to recruit potential participants using snowball sampling. The questionnaire aimed to assess the geo/socioeconomic features and the 5C psychological antecedents of vaccine acceptance (confidence, complacency, constraints, calculation, and collective responsibility). A total of 389 responses were included, with a median age of 37 years (IQR: 28−48), 55.5% males, and 60.7% married participants. Among the studied Nigerian HCWs, only 31.1% showed confidence in MPX vaccination, 58.4% expressed complacency towards vaccination, 63.8% perceived constraints towards MPX vaccination, 27.2% calculated the benefits and risks of vaccination, and 39.2% agreed to receive MPX vaccination to protect others. The determinants of MPX vaccine confidence were being single (OR = 5.07, 95% CI: 1.26−20.34, p = 0.022), a higher education level (with pre-college/high school as a reference, professional/technical: OR = 4.12, 95% CI: 1.57−10.73, p = 0.004, undergraduate: OR = 2.94, 95% CI: 1.32−6.55, p = 0.008, and postgraduate degree (OR = 3.48, 95% CI: 1.51−8.04, p = 0.003), and absence of chronic disease (OR = 2.57, 95% CI: 1.27−5.22, p = 0.009). The significant complacency predictors were having a middle-income (OR = 0.53, 95% CI: 0.33−0.89, p = 0.008), having a bachelor’s degree (OR = 2.37, 95% CI: 1.10−5.11, p = 0.027), and knowledge of someone who died due to MPX (OR = 0.20, 95% CI: 0.05−0.93, p = 0.040). Income was associated with perceived vaccination constraints (OR = 0.62, 95% CI: 0.39−0.99, p = 0.046). Participants aged 46−60 years had decreased odds in the calculation domain (OR = 0.52, 95% CI: 0.27−0.98, p = 0.044). Middle-income and bachelor degree/postgraduate education significantly influenced the collective responsibility domain (OR = 2.10, 95% CI: 1.19−3.69, p = 0.010; OR = 4.17, 95% CI: 1.85−9.38, p < 0.001; and OR = 3.45, 95% CI: 1.50−7.90, p = 0.003, respectively). An investigation of the 5C pattern-based psychological antecedents of MPX vaccination in a sample of Nigerian HCWs revealed low levels of vaccine confidence and collective responsibility with high levels of constraints and complacency. These psychological factors are recommended to be considered in any efforts aiming to promote MPX vaccination needed in a country where MPX is endemic.

Monkeypox: Immune response, vaccination and preventive efforts

Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.

Conspiratorial Attitude of the General Public in Jordan towards Emerging Virus Infections: A Cross-Sectional Study Amid the 2022 Monkeypox Outbreak

Conspiracy theories accompany the emergence of infectious diseases and the 2022 multi-country monkeypox (MPX) outbreak is no exception. It is possible that the adoption of conspiracy beliefs negatively impacts health behavior. We aimed to assess the prevalence of conspiratorial attitudes towards emerging virus infections (EVIs) and the response measures aiming to control these infections among the general public in Jordan. In addition, we assessed MPX knowledge and the belief in the role of men who have sex with men (MSM) in virus spread. The online survey data were collected during 24 May 2022-28 June 2022. The survey instrument was based on previously published scales designed to measure MPX knowledge and EVI conspiracies. A total of 611 respondents formed the final study sample, with a mean age of 44 years and a majority of females (n = 433, 70.9%). On a scale ranging from -10 to +10, the median MPX knowledge score in the study sample was +3 (interquartile range: +1 to +5). Educational level was a determinant of MPX knowledge in multivariate analysis. More than 50% of the participants agreed at least to some extent with 9 out of 12 of the EVI conspiracy items. Multivariate analysis showed that embracing conspiracy beliefs about EVIs was associated with being female, and agreeing with or having no opinion regarding the role of MSM in MPX spread. The current study revealed the high prevalence of belief in conspiracies surrounding EVIs, and its accompanying intervention measures, among the general public in Jordan. In addition, a lower level of MPX knowledge was observed compared to previous studies among university students and health professionals in the country. We recommend evaluating the impact of the widely prevalent conspiracy beliefs on health aspects in future studies. This aim is particularly relevant in the Middle Eastern countries where embracing specific conspiracy ideas is a common occurrence.

Monkeypox Knowledge and Vaccine Hesitancy of Czech Healthcare Workers: A Health Belief Model (HBM)-Based Study

BACKGROUND

The recent human monkeypox virus (HMPXV) outbreak in non-endemic countries that started in May 2022 has raised concerns among public health authorities worldwide. Healthcare workers (HCWs) play a decisive role during epidemics in transmitting accurate information to the public and motivating them to pursue protective behaviours, including immunisation.

METHODS

A cross-sectional survey-based study was conducted in the Czech Republic in September 2022 to evaluate HMPXV-related knowledge and vaccination perceptions among HCWs. The study utilised a digital self-administered questionnaire (SAQ) to collect data from the target population. The proposed SAQ inquired about participants' sociodemographic and anamnestic characteristics, perceived knowledge of HMPXV, factual knowledge, and vaccination perceptions according to the health belief model (HBM).

RESULTS

A total of 341 participants were included in this study; most of them were females (88.9%), allied HCWs (89.4%), heterosexuals (87.1%), married (61.9%), and vaccinated against COVID-19 (91.2%). Only 8.8% of the participants agreed to receive vaccination against HMPXV; 44.9% rejected it, while 46.3% were hesitant. While digital news portals (47.5%) and social media (25.8%) were among the most utilised sources of information about HMPXV, the scientific journals (5.6%), ECDC (5%), and the U.S. CDC (1.5%) were the least common sources. The participants demonstrated suboptimal levels of factual knowledge, especially regarding HMPXV vaccines (1.5 ± 1.2 (0-4)) and treatments (0.9 ± 0.9 (0-4)). Additionally, several misconceptions were detectable among the participants, regarding topics such as the availability of effective vaccines and antivirals against HMPXV, the risk of vertical transmission, and homosexual stigmatisation. The HBM indicated that the cues to action and perceived susceptibility were the most important constructs to predict HMPXV vaccine acceptance.

CONCLUSIONS

the findings of this study call upon public health practitioners and health policymakers in the Czech Republic to act accordingly in order to determine the drivers of vaccine hesitancy among Czech HCWs. Dedicated educational campaigns should aim to counter the HCWs' misconceptions around HMPXV, and future studies should aim to explore the prevalence and drivers of HMPXV vaccine hesitancy among the general population.

Integrated Analgesic Care in the Current Human Monkeypox Outbreak: Perspectives on an Integrated and Holistic Approach Combining Old Allies with Innovative Technologies

Monkeypox (MPX) is a zoonotic infection caused by an orthopoxvirus that is endemic to Central and Western Africa. The MPX virus is a part of the same family of viruses as the variola virus, which causes smallpox. Since May 2022, there has been a global increase in the incidence of MPX infections in multiple countries where the illness is not usually prevalent. A growing number of publications have emphasized on the need for increased awareness among all health professionals for the rapid recognition and diagnosis of this disease and for proper public health measures. However, atypical presentations and occurrence of uncommon symptoms receive less than the desired attention. More specifically, MPX infection related nociceptive symptoms are currently underexposed. Nevertheless, reports from the current outbreak have revealed that (severe) pain is one of the major causes for distress and even hospitalization in these patients. As for all serious pain conditions, an integrated, multidisciplinary, and holistic approach is indicated. This approach should be multimodal and include non-pharmacological therapies alongside pharmacological approaches. Health care professionals should be aware of available alternatives when first choice analgesic therapies fail. Protocols for identification of pain type and prolonged monitoring of clinical status should be implemented to improve patient well-being during acute infection, but also prevent chronic nociceptive syndromes.

Monkeypox Vaccine Hesitancy in French Men Having Sex with Men with PrEP or Living with HIV in France

People with pre-exposure prophylaxis (PrEP) or living with HIV are a high-risk population for monkeypox virus (MPXV) infection. It is important to achieve high MPXV vaccination coverage rates in this group. This project used self-reporting to assess vaccine hesitancy for the smallpox vaccine and acceptance among men having sex with men with PrEP or living with HIV. In total, 52 (33.6%) participants among the 155 declared their hesitancy to be vaccinated against MPXV. Moreover, 20.7% patients with PrEP declared a hesitant attitude towards the smallpox vaccine compared to 40.2% of the HIV patients, p = 0.013. This difference remained not significant after adjustment for age (p = 0.119) and after adjustment for both age and number of different sexual partners (p = 0.406). Among PrEP people, those who expressed concerns about people getting more vaccines than needed (p = 0.012) were less likely to accept vaccination, whereas an increased number of different sexual partners during the previous month was significantly associated with acceptance of vaccination (p = 0.034). Among HIV people, those who expressed concerns about being infected by MPXV (p < 0.001), those who expressed that the smallpox vaccine should be compulsory for people at risk (p < 0.001) and those with an increased the number of different sexual partners the previous month (p = 0.018) were significantly associated with higher acceptance of MPXV vaccination. Our results suggest that vaccine strategy would be efficient in France with a communication strategy emphasizing the benefits of vaccination and the potential MPXV risk infection for health in PrEP and HIV people. Other preventive actions should be implemented, including reduction in sexual partners.

Assessing Healthcare Workers' Knowledge and Their Confidence in the Diagnosis and Management of Human Monkeypox: A Cross-Sectional Study in a Middle Eastern Country

The ongoing multi-country human monkeypox (HMPX) outbreak was declared as a public health emergency of international concern. Considering the key role of healthcare workers (HCWs) in mitigating the HMPX outbreak, we aimed to assess their level of knowledge and their confidence in diagnosis and management of the disease, besides the assessment of their attitude towards emerging virus infections from a conspiracy point of view. An online survey was distributed among HCWs in Jordan, a Middle Eastern country, during May−July 2022 using a questionnaire published in a previous study among university students in health schools in Jordan. The study sample comprised 606 HCWs, with about two-thirds being either physicians (n = 204, 33.7%) or nurses (n = 190, 31.4%). Four out of the 11 HMPX knowledge items had <50% correct responses with only 33.3% of the study respondents having previous knowledge that vaccination is available to prevent HMPX. A majority of study respondents (n = 356, 58.7%) strongly agreed, agreed or somewhat agreed that the spread of HMPX is related to a role of male homosexuals. Confidence in the ability of diagnosis based on the available monkeypox virus diagnostic tests was reported by 50.2% of the respondents, while the confidence levels were lower for the ability to manage (38.9%) and to diagnose (38.0%) HMPX cases based on their current level of knowledge and skills. Higher confidence levels for HMPX diagnosis and management were found among physicians compared to nurses. The endorsement of conspiracy beliefs about virus emergence was associated with lower HMPX knowledge, the belief in the role of male homosexuals in HMPX spread, and with lower diagnosis and management confidence levels. The current study highlighted the gaps in knowledge regarding HMPX among HCWs in Jordan as well as the lack of confidence to diagnose and manage cases among physicians and nurses. Raising the awareness about the disease is needed urgently considering the rapid escalation in the number of cases worldwide with reported cases in the Middle East. The attitude towards male homosexuals’ role in HMPX spread necessitates proper intervention measures to prevent stigma and discrimination among this risk group. The adoption of conspiratorial beliefs regarding virus emergence was widely prevalent and this issue needs to be addressed with proper and accurate knowledge considering its potential harmful impact.