In a recent study published in Tropical Medicine and Infectious Disease, researchers assessed the knowledge, attitudes and practices (KAP) of healthcare workers (HCW) towards monkeypox (MPX) in Italy.
Study: When a neglected tropical disease goes global: knowledge, attitudes and practices of Italian doctors towards monkeypox, preliminary results. Image credit: Guschenkova/Shutterstock
background
MPX is considered a neglected tropical disease caused by the MPX virus (MPXV) endemic in Central and West Africa since the early 1970s; however, an unprecedented MPX outbreak occurred in May 2022 involving non-endemic nations such as Europe, Australia, South America, and North America. People infected with MPXV in non-endemic nations had no established travel links to endemic nations, leading to global health concerns.
About the study
In the present cross-sectional observational study, the investigators assessed the KAP of Italian HCWs towards MPX. The team investigated their attitudes towards variola virus (VARV) vaccines for the prevention of MPX.
The online survey-based pilot study was conducted via Google Forms between May 24 and 31, 2022, and the study sample consisted of Italian front-line healthcare workers who were likely to be involved in the initial management of MPX cases, such as public health (PH) medical professionals, general practitioners (GPs) and occupational physicians (OPs).
The self-reported final questionnaire of the survey included questions on demographics, risk perception and KAP of Italian healthcare workers towards MPX. In addition, data on participants’ previous vaccines against VARV, simian immunodeficiency virus (SIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were obtained. Respondents received no monetary compensation, but received educational information about MPX.
If there were two data entries with the same year of birth, year of graduation, sex, residential and work locations, and occupation, only the first data entry was included in the analysis. A binary logistic regression model was used and risk perception scores (RPS) and adjusted odds ratios (aOR) were calculated.
results
A total of 566 TS responded to the survey, of which only 163 eligible respondents (out of a total of 10,293 potential TS, a response rate of 5.5%) were considered for the final analysis including GP (n=73, 45%), OP (n =49, 30%), and PH (n= 41, 25%). The majority of respondents were women (65%) and their average age was 43 years.
About 27% of respondents were aware of MPX before May 2022; however, knowledge status was unsatisfactory (52%) in all groups of HCWs. The majority of respondents recognized MPXV as a known pathogen (95%), and most cases in Europe were associated with travel to endemic countries (82%).
86% of respondents reported typical skin lesions, although most of them could not really recognize the potential implications of clinical manifestations (only 43% of correct answers) in the prognosis of MPX. The majority of participants reported that the differential diagnosis of MPX skin lesions should include molluscum contagiosum, varicella, herpes simplex infection, syphilis, and typhus (82%) and 58% of respondents reported of inguinal and cervical lymphadenopathy in MPX.
The majority of respondents (79%) reported transmission of MPXV through respiratory droplets, body fluids, and direct contact and that routine disease prevention measures would be adequate to reduce the spread of MPXV (75%). About 44% of respondents recognized MPXV as a multi-host pathogen, and 42% knew about the long-term survival of MPXV on contaminated surfaces.
There were significant knowledge gaps in all aspects of MPX. Findings from the risk perception analysis indicated a significant underestimation of MPXV as a pathogenic organism, particularly when compared to the causative agents of coronavirus disease 2019 (COVID-19), tuberculosis, hepatitis B, and the syndrome of acquired immunodeficiency (AIDS).
Respondents were unsure of the overall incidence of MPX in the previous decade (10,000 cases of MPX). Although 49% of respondents reported that MPXV does not evolve into influenza-like illness, 21% of them overlooked the rates of associated systemic complications, especially in children. Furthermore, only 28% of respondents knew that MPX rashes are synchronous, and 51% of respondents recognized that effective medications were available. Most respondents (72%) recognized that MPXV was less lethal than VARV.
Most participants (78%) identified a case of atypical skin rash, inguinal and/or cervical lymphadenopathy, and a history of travel to MPX-endemic countries as a probable case of MPX, 42% of respondents were uncertain in cases of localization/generalization. vesiculopustular or maculopapular skin eruptions, lymphadenopathy and umbilical skin lesions.
The overall score for MPX as perceived health was 5.4 and 22% of respondents reported that human cases of MPX could be severe (RPS 22%). About 17% of respondents had some confidence in identifying cases of MPX, and 3.7% of respondents mentioned MPX as a common infection in Europe. More than 21% of respondents received VARV vaccinations and ≥2 doses of SARS-CoV-2 vaccines, and 84% received SIV vaccinations in 2021.
More than 64% of respondents favored VARV vaccines and 59% recognized that VARV vaccines were instrumental in preventing MPX. Main effectors of willingness to receive VARV vaccines had received influenza vaccines in the past (aOR 6.4) and favored VARV vaccines for MPX prevention (aOR 21.4). The majority of respondents reported that VARV vaccines had a substantial ability to prevent MPX infections (90%) and systemic complications (91%). However, 32% of them were not willing to pay for VARV vaccines.
conclusion
Overall, the study findings showed substantial knowledge gaps and an erratic perception of MPX risks, underscoring the need for MPX awareness campaigns for Italian front-line healthcare workers.