Abstract
Background
The World Health Organization has declared mpox a Public Health Emergency of International Concern twice. In China, public health professionals (PHPs) involved in infectious disease prevention and control are responsible for mpox control, case reporting, and health communications during outbreaks. This study aimed to assess mpox knowledge and factors associated with sufficient mpox knowledge among PHPs in China.
Methods
This study analyzed PHPs involved in infectious disease prevention and control from a large-scale online cross-sectional survey of healthcare workers conducted through a nationwide platform. An e-questionnaire was used to collect data on demographic and institutional characteristics, attention to mpox, mpox information sources, training history and 37 mpox knowledge items covering etiology, clinical features, transmission, and prevention. Univariable and multivariable logistic regression analyses were performed to identify factors associated with sufficient mpox knowledge.
Results
A total of 1,601 PHPs from 28 of 31 provincial-level regions in China completed the survey, and 1,568 valid responses were included. Among the 1,568 PHPs, 91.3% (1,432/1,568) were aware of mpox, and 61.7% (967/1,568, 95% CI: 59.3%–64.1%) had sufficient mpox knowledge. 44.6% (95% CI: 42.1%–47.0%), 74.2% (95%CI: 72.1%–76.4%) and 47.0% (95% CI: 44.5%–49.5%) PHPs aware of mpox had sufficient knowledge regarding etiology, clinical features and transmission and prevention, respectively. Multivariable logistic regression analysis showed that the associated factors with sufficient mpox knowledge included gender (female: OR = 1.34, 95% CI: 1.03–1.74), professional title (intermediate: OR = 1.85, 95% CI: 1.40–2.45, senior: OR = 2.05, 95% CI: 1.44–2.91), institution (CDC: OR = 2.07, 95% CI: 1.60–2.67), attention toward mpox (occasional: OR = 2.59, 95% CI: 1.72–3.90; daily/frequent: OR = 3.70, 95% CI: 2.39–5.73), mpox information sources (two sources: OR = 1.51, 95% CI: 1.14-2.00; three or more sources: OR = 1.77, 95% CI: 1.31–2.39), and training (OR = 2.44, 95% CI: 1.89–3.15).
Conclusion
This study found insufficient mpox knowledge among the surveyed PHPs involved in infectious disease prevention and control across multiple regions of China, especially among males, those with junior professional titles, limited information access, low attention to mpox, no prior training, and hospital-based staff. Targeted training, continuing education, and multi-channel information dissemination should be strengthened to support mpox preparedness among frontline PHPs.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28260-w.
Keywords: Mpox, Public health professionals, Knowledge, Associated factors, Training
Background
Mpox is a zoonotic orthopoxviral disease caused by the mpox virus (MPXV), clinically characterized by fever, vesiculopustular rash, and lymphadenopathy [1, 2]. Before 2022, mpox was primarily endemic to Central and West Africa, with spillover transmission from infected animals and human-to-human transmission through close contact, particularly sexual contact [1, 3, 4]. The first human case was identified in the Democratic Republic of the Congo in 1970 [5], while the first outbreak outside Africa occurred in the United States in 2003 following contact with imported prairie dogs [6].
In May 2022, a multi-country mpox outbreak emerged across Europe and the Americas, with more than 81,000 laboratory-confirmed cases reported globally by December 2022 [7]. This unprecedented transcontinental spread, which disproportionately affected men who have sex with men (MSM) in non-endemic regions, prompted the World Health Organization (WHO) to declare mpox a Public Health Emergency of International Concern (PHEIC) in July 2022 [8]. Subsequently, a resurgence of mpox led WHO to issue a second PHEIC declaration in August 2024 [9].
In China, the first imported human mpox case on the mainland was confirmed on September 16, 2022 [10]. According to relevant laws and regulations in China, mpox cases are required to be reported to Centers for Disease Control and Prevention (CDCs). Although current epidemiological indicators suggest sustained low-level community transmission, extensive sexual contact networks among MSM populations may maintain transmission risks, highlighting the need for enhanced surveillance and targeted prevention measures [11, 12].
Healthcare workers (HCWs), including public health professionals (PHPs), clinical physicians and nurses, are recognized by WHO as a group at increased risk of infectious disease exposure [13]. In China, PHPs work in CDCs and in public health departments of hospitals at national, provincial, prefectural, and county levels. PHPs in CDCs are responsible for local disease surveillance, disease prevention and control, outbreak response, as well as infectious disease information release and health education. PHPs in hospitals are responsible for infectious disease case reporting and management within their respective institutions.
At the beginning of the mpox outbreak, WHO released epidemic updates and prevention and control guidance. China also formulated and issued relevant official documents and timely epidemic updates, which were disseminated to provincial, prefectural, and county-level medical institutions and CDCs. However, the level of mpox-related knowledge among PHPs involved in infectious disease prevention and control remained unclear. Meanwhile, existing studies have focused mainly on mpox knowledge among clinical physicians [14, 15]. Therefore, based on a large-scale online survey of HCWs conducted through a nationwide platform, this study focused on PHPs involved in infectious disease prevention and control to assess their mpox knowledge and explore factors associated with sufficient knowledge.
Methods
Study population and recruitment
This cross-sectional study was conducted using an online survey among HCWs in China from September 16 to September 29, 2022. The study population was PHPs involved in infectious disease prevention and control, a subset of the cross-sectional survey participants. Participants were recruited using a non-random convenience sampling approach via the Hand in Hand Medical Visit (Xieshou Yifang, in Chinese) platform, an official national health communication and service initiative for sexually transmitted disease (STD) prevention and control. This platform was launched in 2019, administered by the National Health Commission of China and developed by the National Center for STD Control at the Chinese Center for Disease Control and Prevention. As of September 2022, 126,363 HCWs had registered on the platform. Invitation messages were sent to all registered HCWs to invite voluntary participation in the survey.
Inclusion and exclusion criteria
The inclusion criteria were: (1) PHPs working in CDCs or public health departments of hospitals at national, provincial, prefectural, or county levels; (2) PHPs working in CDC divisions responsible for STD/AIDS, infectious disease control and related sectors, as well as hospital PHPs involved in infectious disease case reporting and management; and (3) voluntary participation in the online survey. The exclusion criteria were: (1) not involved in infectious disease prevention and control, including those working in chronic disease management and maternal and child health services; (2) clinical physicians or nurses; and (3) non-voluntary participation in the online survey. The flowchart of study participants is presented in Fig. 1.
Fig. 1.
The flowchart of study participants
Sample size calculation
The sample size required for this survey was calculated using the following binomial proportion formula [16]:
 |
As no previous data on mpox knowledge level were available, a conservative response distribution of 50% (p = 0.50) was used [17]. The total estimated size was 1,574 with a 95% confidence level, a 5% margin of error (E=0.05), and the 50% response distribution.
Questionnaire and design
We developed a structured questionnaire based on authoritative guidelines, including the Interim Rapid Response Guidelines for Mpox (WHO) [18], the Guidelines for the Diagnosis and Treatment of Mpox (2022 edition) [19], and the Technical Guidelines for Mpox Prevention and Control (2022 edition) [20]. The questionnaire showed good reliability (α = 0.87) and validity (KMO = 0.98, P < 0.001). The questionnaire has been detailed in a previous Chinese publication [21], with the English supplementary version provided in the Supplementary File 1.
The questionnaire collected demographic and institutional characteristics, mpox information sources, attention to mpox and mpox-related training history. Mpox knowledge was assessed using 37 items across three domains: etiology (8 items, 8 points), clinical features (15 items, 15 points), and transmission and prevention (14 items, 14 points), yielding a total score of 37 points. For multiple-choice questions, responses were scored as correct only when all correct options were selected without any incorrect options.
Mpox knowledge was categorized according to modified Bloom’s taxonomy, which has been widely used in educational and knowledge assessment studies to classify levels of mastery [22]. Based on previous knowledge, attitude, and practice (KAP) studies and mpox-related knowledge studies using Bloom’s taxonomy-based cutoff criteria, sufficient mpox knowledge was operationally defined as correctly answering at least 70% of the 37 knowledge items [23–25]. Therefore, participants with a total score of ≥ 26 were classified as having sufficient mpox knowledge, whereas those scoring < 26 were classified as having insufficient mpox knowledge.
A pre-specified logical skip rule was applied. Participants who selected “never heard of mpox” were not asked the detailed knowledge questions or subsequent questions on information sources, attention to mpox, and training history. They were assigned a total knowledge score of zero for the overall knowledge assessment but were excluded from item-specific and multivariable regression analyses because the detailed knowledge items and related explanatory variables were not collected.
To ensure data quality, all key questions were mandatory, logical skip rules were embedded in the questionnaire, and each mobile number was allowed to submit only one response to prevent duplicate submissions.
Statistical analysis
Statistical analyses were performed using SPSS 30.0. Normally distributed continuous variables were reported as mean ± SD, non-normally distributed variables as median (IQR), and categorical variables as n (%). Univariable logistic regression analyses were first performed to screen candidate variables. Variables with P < 0.250 in univariable analyses were considered for multivariable logistic regression to avoid prematurely excluding potentially relevant variables that might become significant after adjustment [26, 27]. A forward stepwise logistic regression model was used to identify factors associated with sufficient mpox knowledge and to obtain a parsimonious explanatory model. Backward stepwise logistic regression was also performed to examine the consistency of model selection. Nominal variables were dummy-coded, ordinal predictors were assessed using trend tests, and all tests were two-sided with α = 0.05.
Results
Demographic and institutional characteristics of the study population
A total of 1,601 PHPs from 28 of 31 provincial-level regions, excluding Hainan, Xizang, and Shanghai, voluntarily completed the online survey. After excluding invalid responses, 1,568 valid questionnaires were included in the final analysis, representing a valid response rate of 97.9%. The demographic and institutional characteristics of the 1,568 PHPs are presented in Table 1. PHPs from the Central-South, North, Northeast, East, and West regions accounted for 22.8% (357/1,568), 13.1% (206/1,568), 40.4% (633/1,568), 11.1% (174/1,568), and 12.6% (198/1,568), respectively. The mean age was 39.30 ± 9.88 years, with the youngest being 20 years old and the oldest being 61 years old. 71.0% (1,113/1,568) were females. The majority of the PHPs had bachelor’s degrees, accounting for 84.0% (1,317/1,568). PHPs with junior, intermediate, and senior professional titles accounted for 52.4% (821/1,568), 30.0% (471/1,568), and 17.6% (276/1,568), respectively. PHPs working in CDCs represented 61.5% (964/1,568).
Table 1.
Demographic and institutional characteristics of 1,568 PHPs
| Variables | Total (N = 1,568) |
Aware of mpox (n = 1,432) |
Unaware of mpox (n = 136) |
P |
|---|---|---|---|---|
| Regiona | ||||
| Central-South | 357 (22.8) | 315 (22.0) | 42 (30.9) | 0.034 |
| North | 206 (13.1) | 189 (13.2) | 17 (12.5) | |
| Northeast | 633 (40.4) | 578 (40.4) | 55 (40.4) | |
| East | 174 (11.1) | 168 (11.7) | 6 (4.4) | |
| West | 198 (12.6) | 182 (12.7) | 16 (11.8) | |
| Age | 39.30 ± 9.88 | 39.13 ± 9.82 | 41.10 ± 10.30 | 0.026 |
| Gender | ||||
| Male | 455 (29.0) | 414 (28.9) | 41 (30.1) | 0.761 |
| Female | 1,113 (71.0) | 1,018 (71.1) | 95 (69.9) | |
| Education level | ||||
| Diploma or below | 169 (10.8) | 135 (9.4) | 34 (25.0) | < 0.001 |
| Bachelor | 1,317 (84.0) | 1222 (85.3) | 95 (69.9) | |
| Master or above | 82 (5.2) | 75 (5.2) | 7 (5.1) | |
| Professional title | ||||
| Junior | 821 (52.4) | 738 (51.5) | 83 (61.0) | 0.067 |
| Intermediate | 471 (30.0) | 434 (30.3) | 37 (27.2) | |
| Senior | 276 (17.6) | 260 (18.2) | 16 (11.8) | |
| Institution | ||||
| Hospital | 604 (38.5) | 545 (38.1) | 59 (43.4) | 0.223 |
| CDC | 964 (61.5) | 887 (61.9) | 77 (56.6) | |
| Institutional levelb | ||||
| County | 1,223 (78.0) | 1,121 (78.3) | 102 (75.0) | 0.377 |
| Prefecture or above | 345 (22.0) | 311 (21.7) | 34 (25.0) | |
aRegions were classified according to the standard geographic grouping of the National Bureau of Statistics of China. This study included 28 provincial‑level regions, excluding Hainan Province, Xizang Autonomous Region, and Shanghai Municipality. Detailed regional composition and map are presented in Supplementary Figure S1. bCounty: basic implementation units; Prefecture or above: prefecture/provincial/national authorities.
Among 1,568 PHPs, 91.3% (1,432/1,568) were aware of mpox and 8.7% (136/1,568) were unaware. Participants unaware of mpox were older (41.10 ± 10.30 years) than those aware (39.13 ± 9.82 years) (P = 0.026). The distribution of mpox awareness differed by region (P = 0.034). Among participants unaware of mpox, the largest proportion was from the Northeast region (55/136, 40.4%), while the East region accounted for the smallest proportion (6/136, 4.4%). The distribution of education level also differed by mpox awareness status (P < 0.001). Participants with a diploma or below accounted for a larger proportion among those unaware of mpox (34/136, 25.0%) than among those aware of mpox (135/1,432, 9.4%).
Time of first awareness and attention to mpox
Among 1,432 PHPs aware of mpox, 47.8% (684/1,432) first heard of mpox before April 2022, while 40.7% (583/1,432) first heard of it between April 2022 and the survey period. As for recent attention to mpox, 40.5% (580/1,432) reported frequently engaging with such content over the past six months, whereas 59.5% (852/1,432) indicated they only occasionally or rarely followed updates on the topic.
Mpox information source
Among PHPs aware of mpox, 87.2% (1,249/1,432) obtained mpox information through online new media platforms such as WeChat, Weibo, and Douyin. Another 63.0% (902/1,432) acquired it via traditional channels like television, newspapers, and radio. 32.1% (459/1,432) obtained the information from professional websites, and 17.4% (249/1,432) learned from relatives, friends, or neighbors through word-of-mouth. In total, 39.3% (563/1,432) of participants reported a single information source, 30.6% (438/1,432) reported 2 sources, and 30.1% (431/1,432) reported 3 or more sources.
Mpox-related training
Among PHPs aware of mpox, 55.9% (801/1,432) reported that their institutions had provided mpox-related training or lectures, while 44.1% (631/1,432) reported no such training.
Knowledge level regarding mpox
Among 1,568 PHPs, 61.7% (967/1,568, 95% CI: 59.3%–64.1%) had sufficient mpox knowledge, and only 0.38% (6/1,568, 95% CI: 0.1%–0.8%) participants correctly answered all the knowledge questions. Correct responses for each knowledge item were calculated among the 1,432 participants aware of mpox and completed the knowledge questionnaire.
Etiology of mpox
The median score for this section was 5 (3, 7), accounting for only 62.5% (5/8) of this domain. Only 44.6% (95% CI: 42.1%–47.0%) PHPs aware of mpox had sufficient knowledge regarding etiology. While 86.1% correctly identified “Effective inactivation methods for MPXV”, only 43.2% recognized “MPXV and varicella-zoster virus are not in the same family” (Table 2).
Table 2.
Correct response rates for mpox etiology knowledge among 1,432 PHPs aware of mpox
| Knowledge items | Correct (%) |
|---|---|
| MPXV is a double-stranded DNA virus. | 76.3 |
| MPXV can be cultured in vitro. | 57.1 |
| MPXV, along with the variola virus, vaccinia virus, and cowpox virus, belongs to the genus Orthopoxvirus within the family Poxviridae. Its infectivity and pathogenicity are weaker than those of the variola virus. | 67.7 |
| There is cross-immunity between MPXV and the variola virus. | 65.5 |
| MPXV and varicella-zoster virus are not in the same family. | 43.2 |
| MPXV has two clades: West African and Congo Basin. | 52.0 |
| Appropriate survival conditions for MPXV. | 51.6 |
| Effective inactivation methods for MPXV. | 86.1 |
Clinical features of mpox
The median score for this section was 12 (9, 13), accounting for only 80.0% (12/15) of this domain. Overall, 74.2% (95% CI: 72.1%–76.4%) participants had sufficient knowledge regarding clinical features. While 89.8% correctly identified “Clinical symptoms in the prodromal phase of mpox infection.”, only 32.0% recognized “Criteria for diagnosing confirmed mpox cases.” (Table 3).
Table 3.
Correct response rates for mpox clinical features knowledge among 1,432 PHPs aware of mpox
| Knowledge items | Correct (%) |
|---|---|
| The incubation period of the MPXV is typically 6–13 days. | 50.4 |
| The shortest and longest incubation period range of the MPXV is 5–21 days. | 50.4 |
| Clinical symptoms in the prodromal phase of mpox infection. | 89.8 |
| Mpox rashes go through several stages of changes, from macules, papules, vesicles, pustules to scabs which appear around 10 days. | 76.9 |
| Characteristics of mpox rashes. | 41.8 |
| Main locations where mpox-induced rashes occur. | 88.3 |
| Differential diagnosis of mpox. | 86.6 |
| Laboratory testing methods for mpox. | 88.0 |
| Criteria for judging suspected mpox cases. | 80.2 |
| Criteria for diagnosing confirmed mpox cases. | 32.0 |
| Before treating a mpox patient, it is necessary to inquire whether the patient is infected with HIV. | 80.2 |
| Currently, there are no specific anti-MPXV drugs in China. Treatment mainly focuses on symptomatic support and prevention and treatment of complications. | 82.4 |
| Complications that may occur in severe mpox patients. | 86.3 |
| High-risk groups for mpox complications. | 89.3 |
| Mpox can cause patient death. | 84.4 |
Transmission and prevention of mpox
The median score for this section was 10 (9, 12), accounting for 71.4% (10/14) of this domain. Overall, 47.0% (95% CI: 44.5%–49.5%) participants had sufficient knowledge regarding transmission and prevention. While 93.7% correctly identified “If you have contact with a close contact of a mpox case or a mpox patient, what are your handling measures?”, only 41.6% recognized “Populations eligible to receive the mpox vaccine in the United States.” (Table 4).
Table 4.
Correct response rates for mpox transmission and prevention among 1,432 PHPs aware of mpox
| Knowledge items | Correct (%) |
|---|---|
| Mpox is a zoonotic disease. | 88.3 |
| The main hosts of the MPXV. | 50.8 |
| The sources of infection of the MPXV | 76.3 |
| Mpox infection can be divided into two stages: the prodromal stage and the rash stage. The rash stage is more contagious. | 60.7 |
| The transmission routes of mpox. | 61.7 |
| Contact methods for transmitting mpox. | 90.6 |
| Populations susceptible to mpox. | 93.3 |
| Preventive measures against mpox. | 92.5 |
| Is it necessary to receive the mpox vaccine after getting vaccinated against smallpox? | 64.6 |
| Mpox vaccines are already available in the United States. | 44.4 |
| Populations eligible to receive the mpox vaccine in the United States | 41.6 |
| If a close contact of a mpox case or a mpox patient asks you for help, what are your prevention and treatment suggestions for them? | 92.9 |
| If you have contact with a close contact of a mpox case or a mpox patient, what are your handling measures? | 93.7 |
| Once a suspected or confirmed mpox case is identified, it should be reported directly through the monitoring and reporting management module of the China Information System for Disease Control and Prevention within 24 h. | 54.8 |
Factors associated with mpox knowledge among PHPs
Univariable and multivariable logistic regression analyses were performed among 1,432 PHPs who were aware of mpox and had complete data on the core variables. The 136 participants who had never heard of mpox were excluded from these analyses because the detailed knowledge items and related explanatory variables were not collected due to the questionnaire skip rule. Results of the univariable logistic regression analysis showed that variables such as region, age, gender, educational level, professional title, institution, institution level, attention to mpox, mpox information sources, and mpox-related training had P < 0.250 and were considered candidates for multivariable analysis.
The variables retained were consistent between the forward and backward stepwise models; therefore, the forward stepwise results are presented in Table 5. In the final multivariable model, gender, professional title, institution, attention to mpox, mpox information sources, and mpox-related training were significantly associated with sufficient mpox knowledge. Specifically, females were more likely to have sufficient mpox knowledge than males (OR = 1.34, 95% CI: 1.03–1.74). PHPs with intermediate (OR = 1.85, 95% CI: 1.40–2.45) and senior professional titles (OR = 2.05, 95% CI: 1.44–2.91) were more likely to have sufficient mpox knowledge than those with junior professional titles. Compared with hospital-based PHPs, those working in CDCs had higher odds of sufficient mpox knowledge (OR = 2.07, 95% CI: 1.60–2.67). Participants who occasionally paid attention to mpox (OR = 2.59, 95% CI: 1.72–3.90) or paid daily/frequent attention to mpox (OR = 3.70, 95% CI: 2.39–5.73) were more likely to have sufficient mpox knowledge than those who rarely paid attention to mpox. Accessing two sources (OR = 1.51, 95% CI: 1.14–2.00) or three or more sources of mpox information (OR = 1.77, 95% CI: 1.31–2.39) was associated with higher odds of sufficient mpox knowledge compared with accessing a single source. Participants who had received mpox-related training were more likely to have sufficient mpox knowledge than those without training (OR = 2.44, 95% CI: 1.89–3.15).
Table 5.
Sufficient mpox knowledge and associated factors among 1,432 PHPs aware of mpox
| Variables | Total (N = 1,432) |
Number with sufficient knowledge (n = 967) |
Sufficient knowledge (%) |
Univariable analysis | Multivariable analysis | ||
|---|---|---|---|---|---|---|---|
| OR (95% CI) | P | Adjusted OR (95% CI) |
P | ||||
| Region | |||||||
| Northeast | 578 | 376 | 65.1 | 1 | |||
| North | 189 | 129 | 68.3 | 1.16 (0.81–1.64) | 0.421 | – | – |
| East | 168 | 122 | 72.6 | 1.43 (0.98–2.08) | 0.068 | – | – |
| Central-South | 315 | 206 | 65.4 | 1.02 (0.76–1.36) | 0.918 | – | – |
| West | 182 | 134 | 73.6 | 1.50 (1.04–2.17) | 0.032 | – | – |
| Age | |||||||
| 20~ | 296 | 169 | 57.1 | 1 | |||
| 30~ | 425 | 276 | 64.9 | 1.39 (1.03–1.89) | 0.033 | – | – |
| 40~ | 446 | 322 | 72.2 | 1.95 (1.43–2.66) | < 0.001 | – | – |
| 50~ | 265 | 200 | 75.5 | 2.31 (1.61–3.32) | < 0.001 | – | – |
| Gender | |||||||
| Male | 414 | 266 | 64.3 | 1 | 1 | ||
| Female | 1,018 | 701 | 68.9 | 1.23 (0.97–1.57) | 0.092 | 1.34 (1.03–1.74) | 0.028 |
| Education level | |||||||
| Diploma or below | 135 | 79 | 58.5 | 1 | 1 | ||
| Bachelor | 1,222 | 837 | 68.5 | 1.54 (1.07–2.22) | 0.020 | 1.45 (0.98–2.15) | 0.067 |
| Master or above | 75 | 51 | 68.0 | 1.51 (0.83–2.73) | 0.176 | 1.29 (0.65–2.56) | 0.464 |
| Professional title | |||||||
| Junior | 738 | 443 | 60.0 | 1 | 1 | ||
| Intermediate | 434 | 321 | 74.0 | 1.89 (1.46–2.45) | < 0.001 | 1.85 (1.40–2.45) | < 0.001 |
| Senior | 260 | 203 | 78.1 | 2.37 (1.71–3.29) | < 0.001 | 2.05 (1.44–2.91) | < 0.001 |
| Institution | |||||||
| Hospital | 545 | 325 | 59.6 | 1 | 1 | ||
| CDC | 887 | 642 | 72.4 | 1.77 (1.42–2.22) | < 0.001 | 2.07 (1.60–2.67) | < 0.001 |
| Institutional level | |||||||
| County | 1121 | 746 | 66.5 | 1 | |||
| Prefecture or above | 311 | 221 | 71.1 | 1.23 (0.94–1.63) | 0.133 | – | – |
| Attention to mpox | |||||||
| Rare | 132 | 50 | 37.9 | 1 | 1 | ||
| Occasional | 720 | 471 | 65.4 | 3.10 (2.11–4.55) | < 0.001 | 2.59 (1.72–3.90) | < 0.001 |
| Daily or frequent | 580 | 446 | 76.9 | 5.46 (3.66–8.15) | < 0.001 | 3.70 (2.39–5.73) | < 0.001 |
| Mpox information sources | |||||||
| Single | 563 | 332 | 59.0 | 1 | 1 | ||
| Two | 438 | 307 | 70.1 | 1.63 (1.25–2.13) | < 0.001 | 1.51 (1.14-2.00) | 0.004 |
| Three or more | 431 | 328 | 76.1 | 2.22 (1.68–2.93) | < 0.001 | 1.77 (1.31–2.39) | 0.001 |
| Mpox training | |||||||
| No | 631 | 358 | 56.7 | 1 | 1 | ||
| Yes | 801 | 609 | 76.0 | 2.42 (1.93–3.03) | < 0.001 | 2.44 (1.89–3.15) | < 0.001 |
“–” The variable was not retained in the final multivariable model after stepwise variable selection
Discussion
This study assessed mpox knowledge among 1,568 surveyed PHPs involved in infectious disease prevention and control in China and explored factors associated with sufficient mpox knowledge. We found that only 61.7% of the surveyed PHPs had sufficient mpox knowledge. Although this proportion was higher than that reported among physicians (55.0%) and nurses (58.0%) [28, 29], it remained insufficient among PHPs responsible for infectious disease prevention and control. Notably, only 0.38% of participants correctly answered all the knowledge questions, indicating a very low proportion of complete mastery among the surveyed PHPs.
In this study, we found that region, age, and education level were associated with mpox unawareness among surveyed PHPs. Among PHPs aware of mpox, those with intermediate or senior professional titles, employment in CDCs, multiple mpox information sources, higher attention to mpox, and mpox-related training were more likely to have sufficient mpox knowledge. Notably, PHPs with intermediate and senior professional titles were more likely to have sufficient mpox knowledge than junior PHPs, which is consistent with China’s competency-based professional certification system [30]. However, due to the cross-sectional design, these associations should not be interpreted as causal effects. These findings identify priority groups for future training and information dissemination, particularly PHPs with junior professional titles, limited information access, low attention to mpox, and no prior mpox-related training.
Moreover, in the overall knowledge assessment among all surveyed PHPs, a higher proportion of PHPs working in CDCs (66.6%) had sufficient mpox knowledge than hospital-based PHPs (53.8%), which is consistent with the findings of Peng et al. [31]. Hospital-based PHPs are often involved in infectious disease case reporting and management within healthcare facilities. Therefore, the relatively lower level of mpox knowledge observed among hospital-based PHPs may indicate potential gaps in preparedness for case identification, reporting, and initial response. These findings suggest that targeted mpox-related training and continuing education should be strengthened for hospital-based PHPs.
Enhancing mpox knowledge among PHPs is important for strengthening preparedness for mpox prevention and control. Effective public health surveillance, risk communication, and early response depend partly on the professional capacity of PHPs, underscoring the need for a comprehensive understanding of the disease [32]. In our study, only 44.6% and 47.0% of participants demonstrated sufficient knowledge of mpox etiology and transmission and prevention, respectively. These findings indicate important knowledge gaps in domains closely related to case identification, risk assessment, and prevention practices. Therefore, targeted and timely educational interventions may be warranted [33]. Healthcare and public health institutions should consider integrated, systematic, and multi-channel training and continuing education programs through both traditional and digital platforms, with tailored content for PHPs in hospitals, CDCs, and other settings, to support sustained attention to and accurate understanding of mpox.
For future practice, continuous education and targeted training for frontline PHPs should be strengthened to support early detection, risk communication, and emergency response for mpox and other emerging infectious diseases. Our findings highlight the importance of routine training, standardized professional development, and multi-channel information dissemination in strengthening mpox preparedness and supporting the prevention and control of zoonotic diseases in China.
Limitations
This study has several limitations. First, the cross-sectional design precludes causal inference. Therefore, the observed associations between mpox knowledge and related factors, including mpox-related training, information sources, and attention to mpox, should be interpreted as exploratory rather than causal. Second, although invitation messages were distributed through a nationwide online platform and valid responses were obtained from 28 of 31 provincial-level regions, participants were recruited using a voluntary convenience sampling strategy. PHPs who were more familiar with online professional platforms or more interested in emerging infectious diseases may have been more likely to participate, which may have introduced selection bias and potentially overestimated the mpox knowledge level. In addition, several provincial-level regions were not represented, and no weighting or post-stratification adjustment was performed. Therefore, the findings should be interpreted as reflecting the surveyed PHPs rather than nationally representative estimates for all PHPs in China. Third, participants who had never heard of mpox were assigned a total knowledge score of zero for the overall knowledge assessment, which may have affected the estimated proportion with sufficient mpox knowledge. They were excluded from item-specific and regression analyses because relevant knowledge items and explanatory variables were not collected due to the questionnaire skip rule. Therefore, the regression findings should be interpreted as applying to PHPs who were aware of mpox. Finally, the use of an online self-administered questionnaire may have introduced information bias, although several quality control measures were applied. This study focused only on PHPs involved in infectious disease prevention and control, and did not include clinical physicians, nurses, or PHPs not involved in infectious disease prevention and control. In addition, some potentially relevant factors, such as work experience, specific job responsibilities, previous outbreak response experience, and self-efficacy in mpox prevention and control, were not collected, which may have led to residual confounding.
Conclusions
This study found insufficient mpox knowledge among the surveyed PHPs involved in infectious disease prevention and control across multiple regions of China, particularly among males, PHPs with junior professional titles, those with limited information access, low attention to mpox, no prior mpox-related training, and hospital-based staff. These findings identify priority groups for future capacity-building efforts and highlight the need for targeted continuing education, specialized training, and multi-channel information dissemination to support mpox preparedness among frontline PHPs.
Supplementary Information
Acknowledgements
We would like to thank all authors who participated in this study, as well as all volunteers involved in the research. Additionally, we express our gratitude to all participants who made this study possible.
Abbreviations
- PHPs
public health professionals
- MPXV
mpox virus
- MSM
men who have sex with men
- WHO
World Health Organization
- PHEIC
Public Health Emergency of International Concern
- HCWs
healthcare workers
- CDCs
Chinese Centers for Disease Control and Prevention
- STD
sexually transmitted disease
- KAP
knowledge, attitude, and practice
- SD
standard deviation
- CI
confidence interval
- OR
odds ratio
Authors' contributions
MH conducted the data curation/analysis, and manuscript drafting. WZ and YW conducted the study design and data curation. ZC conducted the data curation and analysis. SL and YX conducted the data curation. XY, JL and JZ provided guidance on the research. XG conducted the study design/provided research guidance and revised the manuscript.
Funding
This work was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS-2021-I2M-1-001). The funder had no role in the study design, data collection, data analysis, data interpretation, or article writing.
Data availability
The data collected and questionnaire in this study will not be publicly available. However, the corresponding author can be contacted for de-identified data and questionnaire upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was reviewed and approved by the Ethics Committee of the Institute of Dermatology, Chinese Academy of Medical Sciences (Approval No.: 2022-KY-042). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki and relevant national ethical guidelines. Before completing the online questionnaire, all participants were informed of the study purpose, the voluntary nature of participation, the confidentiality of the collected data, and their right to decline or withdraw from the survey. Electronic informed consent to participate was obtained from all participants prior to their participation.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data collected and questionnaire in this study will not be publicly available. However, the corresponding author can be contacted for de-identified data and questionnaire upon reasonable request.