Knowledge, attitudes, and practices of medical professionals towards monkeypox in Italy

In a recent study published in Tropical Medicine and Infectious Disease, researchers assessed the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) towards monkeypox (MPX) in Italy.

Background

MPX is considered a neglected tropical illness caused by the MPX virus (MPXV) endemic to Central and Western Africa since the early 70s; however, an unprecedented MPX outbreak occurred in May 2022 involving non-endemic nations such as Europe, Australia, South America, and North America. MPXV-infected individuals in non-endemic nations had no established travel links to endemic nations, raising global health concerns.

About the study

In the present cross-sectional observational study, researchers assessed the KAP of Italian HCWs towards MPX. The team inquired into their attitudes toward variola virus (VARV) vaccinations for MPX prevention.

The online survey-based pilot study was conducted via Google forms between 24 and 31 May 2022, and the study sample comprised Italian first-line HCWs likely to be involved in the initial management of MPX cases, such as public health medical professionals (PH), general practitioners (GP), and occupational physicians (OP).

The final self-reported questionnaire of the survey comprised questions on demographics, risk perception, and KAP of Italian HCWs towards MPX. In addition, data on the previous VARV, simian immunodeficiency virus (SIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations were obtained from the participants. The respondents were not provided with any monetary compensation but received educational information about MPX.

If there were two data entries with the same birth year, graduation year, sex, residential and work locations, and occupation, only the first data entry was included in the analysis. Binary logistic regression modeling was used, and the risk perception scores (RPS) and adjusted odds ratios (aOR) were calculated.

Results

A total of 566 HCWs responded to the survey, of which only 163 eligible respondents (out of 10,293 potential HCWs, a response rate of 5.5%) were considered for the final analysis comprising GP (n=73, 45%), OP (n=49, 30%), and PH (n= 41, 25%). Most survey respondents were females (65%), and their average age was 43.  

About 27% of the respondents were aware of MPX before May 2022; however, the knowledge status was unsatisfying (52%) across all HCW groups. Most respondents recognized MPXV as a known pathogenic organism (95%), and most cases in Europe were associated with travel to endemic nations (82%).

Typical cutaneous lesions were reported by 86% of respondents, although most of them could not truly recognize the potential implications of clinical manifestations (only 43% correct answers) on MPX prognosis. Most participants reported that the differential diagnosis for MPX cutaneous lesions must include Molluscum contagiosum infections, varicella, Herpes simplex infection, syphilis, and typhus (82%) and inguinal and cervical lymphadenopathy in MPX was reported by 58% of the respondents.

Most of the respondents (79%) reported MPXV transmission via respiratory droplets, bodily fluids, and direct contact and that usual measures for disease prevention would be adequate to curtail MPXV spread (75%). About 44% of the respondents recognized MPXV as a pathogenic organism with multiple hosts, and 42% knew about long-term MPXV survival on contaminated surfaces.

There were significant knowledge gaps in all MPX aspects. The risk perception analysis findings indicated a significant overlooking of MPXV as a pathogenic organism, especially in comparison with causative agents of coronavirus disease 2019 (COVID-19), tuberculosis, hepatitis B, and acquired immunodeficiency syndrome (AIDS).

The respondents were uncertain of the global MPX incidence in the previous decade (10,000 MPX cases). Although 49% of respondents reported that MPXV does not evolve in influenza-like illnesses, 21% of them overlooked the associated systemic complication rates, especially in children. Furthermore, a mere 28% of respondents knew that MPX cutaneous rashes are synchronous, and 51% of the respondents acknowledged that effective medications were available. Most respondents (72%) acknowledged that MPXV was less lethal than VARV.  

Most of the participants (78%) identified a case of atypical skin rash, inguinal and/or cervical lymphadenopathy, and travel history to MPX-endemic nations as a probable case of MPX, 42% of respondents were uncertain in cases of localized/generalized vesiculopustular or maculopapular cutaneous rashes, lymphadenopathy, and umbilicated cutaneous 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 MPX case identification, and 3.7% of respondents mentioned MPX as a frequent infection in Europe. Over 21% of respondents received VARV vaccinations and ≥2 doses of SARS-CoV-2 vaccines, and 84% received SIV vaccinations in 2021.

Over 64% of respondents favored VARV vaccinations, and 59% acknowledged that VARV vaccines were instrumental in MPX prevention. The prime effectors of willingness to receive VARV vaccinations had received influenza vaccinations (aOR 6.4) in the past and favored VARV vaccines for MPX prevention (aOR 21.4). Most respondents reported that VARV vaccines had a substantial ability to prevent MPX infections (90%) and systemic complications (91%). However, 32% of them were unwilling to make payments for VARV vaccinations.

Conclusion

Overall, the study findings showed substantial knowledge gaps and erratic perception of MPX risks, underscoring the need for MPX awareness campaigns for first-line Italian HCWs.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.