Abstract
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.
Keywords: Monkeypox, Knowledge, Attitude, vaccines, Algeria
Abstract
Objectivos
Este estudio se llevó a cabo para evaluar el nivel de conocimiento de los trabajadores de la salud argelinos sobre la viruela del simio humano y su actitud hacia su vacunación.
Métodos
Entre el 28 de junio y el 18 de septiembre de 2022 se llevó a cabo un estudio transversal en línea utilizando plataformas de redes sociales dirigido a trabajadores de la salud argelinos.
Resultados
111 rabajadores de la salud han respondido al cuestionario. En general se obtuvo un nivel de conocimiento medio (64,9%) con múltiples lagunas sobre la epidemiología y clínica de esta enfermedad. Los factores asociados con altos niveles de conocimiento incluyen la edad joven, estar casado y ejercer fuera de la ciudad de la provincia. Además, solo el 38,7% de los encuestados estaba a favor de la viruela del simio humano si la vacunación se recomendaba de forma gratuita con la aceptación de la vacuna COVID-19 como factor determinante de la aceptación.
Conclusión
Los resultados han mostrado un nivel medio de conocimiento y una baja tasa de disposición a la vacunación. Los hallazgos de este estudio podrían ser una línea de base para el conocimiento y la vacunación contra la viruela del simio humano en Argelia.
Palabras clave: Viruela del mono, conocimiento, actitud, vacunas, Argelia
Introduction
After the COVID-19 pandemic and its drastic consequences and sequelae, the world has been facing a new public health threat since May 6th 2022 as a result of the re-emergence of human monkeypox (HMPX) in different non endemic countries.1 The rapid spread of this disease has engendered a number of 66,551 cases. Prior to this, the WHO had declared the human monkeypox outbreak a public health emergency of international interest since July 2022.2 , 3
This disease is caused by monkeypox virus; a double-stranded DNA virus, one of the four Orthopoxvirus species pathogenic for humans with variola virus, cowpox virus, and vaccinia virus.4 , 5 The clinical picture of this disease shows suggestive small pox signs with an incubation period of 6 to 13 days (range from 5 to 21 days) and the formation of self-limiting lesions, skin nodules or disseminated rash that could be severe in some individuals, like children, pregnant women or immune-deficient persons. The case fatality rate of this disease varied from 3.6% to 10.6% in the endemic countries.1 , 5 Despite the name of monkeypox, the natural reservoir of this disease is still unknown.3 The virus is mainly transmitted from person to person close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.
Although HMPX has not been notified in Algeria, reported cases in some Arab countries including Bahrain, Egypt, Morocco, Qatar, Lebanon, Saudi Arabia, Sudan and United Arab Emirates3 puts the country at risk of its emergence which necessitates vigilant preparedness and response plans. In this way, healthcare workers (HCWs) are considered as a key group in any preventive measure to limit the spread of this disease.6 Thus, prompt assessment of their preparedness and their knowledge and awareness could be of great importance.7 This topic has been touched upon in many previous studies around the world.7, 8, 9, 10, 11, 12
Considering this context, the current study was conducted to evaluate the level of knowledge of Algerian healthcare workers about HMPX and their attitude toward HMPX vaccines.
Materials and methods
A cross-sectional Web-based survey was carried out in Algeria to evaluate knowledge and awareness of healthcare workers living and practicing in Algeria about human monkeypox and their attitude towards its vaccines, using self-administered questionnaire (SAQ). It was conducted between 28 June and 18 September 2022 by disseminating the Google Forms (Google LLC, Menlo Park, CA, USA, 2021) link on social media platforms in relation with the target population.
Participation in this study was voluntary and no financial incentives or compensations have been given. The participants’ identity was kept anonymous to control Hawthorne’s effect and information bias.
The SAQ was adopted from previous studies regarding attitude and knowledge about monkey pox in different countries10, 11, 12 and was administered in Arabic and French languages. It contains 22 multiple-choice items that were stratified into three sections: socio-demographic and professional characteristics (sex, age), knowledge level (using 23 knowledge items with yes/no responses) and attitude toward monkeypox vaccines. To estimate the knowledge level, each item was given a score of one for a correct response and a score of zero for an incorrect response. The scores of the 23 items were added up defining the final score that ranges from 0 to 23, with higher scores indicating better knowledge on HMPX. Finally, the mean level of was calculated (estimated at 14.9) and was used as a point cut-off to dichotomize the knowledge level as high or low as described previously.13
Statistical analysis
Data were analyzed using SPSS version 22.0 (SPSS Inc. Chicago, IL, USA, 2011). They were first presented as frequencies (n) and percentages (%) or mean ± SD for the score knowledge. Chi squared (χ2) and Ficher tests were used to assess the association between dependent and independent variables.
Subsequently, multinomial logistic regression was used to determine the suggested associated factors with HMPX knowledge an attitude toward HMPX vaccines. All statistical analyses have been performed with a confidence level (CI) of 95% and a significance level (Sig.) of ≤ 0.05.
Results
Overall, 111 healthcare workers have completed the questionnaire of this study. The general characteristics of the study population are shown in Table 1 . The population was dominated by females (70.3%), single individuals (60.4%), and those living in urban areas (91%) and aged between 18 and 30 years (61.3%).
Table 1.
General characteristics of the study population.
| Variable | Numbrer | Frequency | |
|---|---|---|---|
| Age | 18–30 years old | 68 | 61.3 |
| 31–40 years old | 28 | 25.2 | |
| Overr 40 Years old | 15 | 13.5 | |
| Sexe | Female | 78 | 70.3 |
| Male | 33 | 29.7 | |
| Marital Status | Married | 44 | 39.6 |
| Single | 67 | 60.4 | |
| Residence | Rural | 10 | 9.0 |
| Urban | 101 | 91.0 | |
| Occupation | Physicians | 45 | 40.5 |
| Pharmacists | 8 | 7.2 | |
| Paramedics | 25 | 22.5 | |
| Veterinarians | 3 | 2.7 | |
| Biologiste | 2 | 1.8 | |
| Lab staff | 2 | 1.8 | |
| Students | 26 | 23.4 | |
| Professional experience | Without | 31 | 27.9 |
| Less than 2 years | 18 | 16.2 | |
| 2–5 years | 28 | 25.2 | |
| 6–10 years | 15 | 13.5 | |
| More than 10 years | 19 | 17.1 | |
| Sector | Private | 13 | 11.7 |
| Public | 98 | 88.3 | |
| Working place | Province | 66 | 59.5 |
| Daïra | 25 | 22.5 | |
| Municipality | 20 | 18.0 | |
| Attended regional conferences | Yes | 50 | 45.0 |
| No | 61 | 55.0 | |
| Attended national conferences | Yes | 36 | 32.4 |
| No | 75 | 67.6 | |
| Attended international conferences | Yes | 19 | 17.1 |
| No | 92 | 82.9 | |
| Influenza vaccine uptake | Yes | 37 | 33.3 |
| No | 74 | 66.7 | |
| COVID-19 vaccine uptake | Yes | 55 | 49.5 |
| No | 56 | 50.5 |
Regarding their professional status, physicians (40.5%) were the most represented category followed by students (23.4%) and paramedics (22.5%). The majority were practicing in the public sector (88.3%), generally in the province town (59.5%) and most of them were without any practice experience (27.9%) or with a professional experience of 2 to 5 years (25.2%). For their connection to scientific events, 45% of the respondents declared attending province level conference while, 32% and 17% declared that they attended national and international level conference respectively. In terms of their vaccination status, almost half (49.5%) of respondents were vaccinated against COVID-19 while one third (33.3%) only received influenza vaccine.
Human monkeypox knowledge
Results showed that 91.9 % of the respondents were aware of the current monkeypox pandemic while 61.3% had not heard of this disease before 2022.
Also, 46.7% of the respondents considered that this topic was normally treated by media, while 24.8% considered that it was overly publicized and the remaining portion (29.4%) saw the disease to be under-mediated. Consequently, 40% of the respondents declared being worried about the evolution of this disease while 36.2% said the opposite and 23.8% of them were indifferent.
Results showed that the mean level of knowledge was estimated at 64.9%. Furthermore, more than half (52.2%) of the knowledge items had a lower rate of correct responses than 70% and about three quarters (73.9%) had a lower rate than 80%. Additionally 34.2% didn’t know that there is vaccine (even not widely available) against monkeypox and almost a half (49.1%) knew that small pox vaccines are effective against monkeypox (Supplementary material).
Regarding the knowledge score, the mean score was estimated at 14.9 + 4.5 (of a maximum of 23). This score was used as a cut off for further analysis.
Factors associated with high levels of knowledge
Results of the univariate analysis showed that being a physician/pharmacist was significantly associated with high level of knowledge (Sig.<0.01) while paramedics were associated with the lower rates (Sig.<0.01). Additionally married individuals (Sig.=0.03) and those who attended regional (Sig.=0.03), national (Sig.=0.026) and international conferences (Sig.<0.01) had the highest level than their counterparts.
Results of the logistic regression showed however that, only younger individuals, married and those practicing out of the province were associated with the highest OR of high levels of knowledge (Table 2 ).
Table 2.
Factors associated with high level of knowledge about HMPX.
| Variables | High (%) | Low (%) | Sig. | OR (CI 95 %) | Sig. | |
|---|---|---|---|---|---|---|
| Age | 18–30 years old | 40 (58.8) | 28 (41.2) | 0.244 | 183.404 (4.81–6993.117) | 0.005 |
| 31–40 years old | 21(75) | 7 (25) | 0.13 | 30.005 (1.819–494.833) | 0.017 | |
| Over 40 years old | 9 (60) | 6 (40) | 0.781* | . | . | |
| Sexe | Female | 49 (62) | 29 (38) | 0.935 | 0.945 (0.285–3.129) | 0.926 |
| Male | 21 (63) | 12 (37) | . | . | ||
| Marital Status | Married | 33 (75) | 11 (25) | 0.0347 | 5.136 (1.19–22.162) | 0.028 |
| Single | 37 (55.2) | 30 (44.8) | . | . | ||
| Residence | Rural | 5 (50) | 5 (50) | 0.494* | 0.353 (0.058–2.137) | 0.257 |
| Urban | 65 (64.4) | 36 (35.8) | . | . | ||
| Occupation | Physician/pharmacist | 43 (81.1) | 10 (18.9) | 0.0001 | 0.778 (0.053–11.531) | 0.855 |
| Paramedics | 9 (36) | 16 (64) | 0.002* | 0.057 (0.003–1.092) | 0.057 | |
| Students | 12 (46.2) | 14 (55.8) | 0.07 | 0.224 (0.011–4.668) | 0.334 | |
| Others | 6 (85.7) | 1 (14.3) | 0.257* | . | . | |
| Professional experience | Less than 2 years | 11 (61.1) | 7 (38.9) | 1* | 0.302 (0.047–1.926) | 0.205 |
| 2–5 years | 19 (67.9) | 9 (32.1) | 0.543 | 1.28 (0.224–7.315) | 0.781 | |
| 6–10 years | 11 (73.3) | 4 (26.7) | 0.566* | 2.73 (0.288–25.867) | 0.381 | |
| More than 10 years | 13 (68.4) | 6 (31.2) | 0.795* | 11.801 (0.531–262.378) | 0.119 | |
| Without | 16 (51.6) | 15 (48.4) | 0.12 | . | . | |
| Sector | Private | 12 (92.3) | 1 (7.7) | 0.029* | 10.035 (0.379–265.897) | 0.168 |
| Public | 58 (59.2) | 40 (40.8) | . | . | . | |
| Working place | Out of province | 32 (71.1) | 13 (28.9) | 0.147 | 3.8 (1.075–13.43) | 0.038 |
| Province | 38 (57.6) | 28 (42.4) | . | . | ||
| Attended regional conferences | Yes | 37 (54) | 13 (46) | 0.03 | 2.31 (0.679–7.856) | 0.18 |
| No | 33 (54.1) | 28 (45.9) | . | . | ||
| Attended national conferences | Yes | 28 (77.8) | 8 (22.2) | 0.026 | 1.253 (0.339–4.628) | 0.735 |
| No | 42 (56) | 33 (44) | . | |||
| Attended international conferences | Yes | 17 (89.5) | 2 (10.5) | 0.009* | 5.232 (0.72–38.029) | 0.102 |
| No | 53 (57.6) | 39 (42.4) | . |
Data were analyzed using Chi-squared and Fisher (*) tests. Bold character indicates results with a significance difference (Sig.≤0.05).
Vaccination intention
Results showed that 38.7% among the asked healthcare workers were willing to be vaccinated if recommended in the near future. Factors associated with being in favour of vaccination included exclusively those who received COVID-19 vaccine (Sig.<0.01). This result was confirmed using multinomial logistic regression (OR = 5.484, Sig. = 0.001) (Table 3 ).
Table 3.
Factors associated with intention to get HMPX vaccine.
| Variables | Yes (%) | No (%) | Sig. | OR (CI 95%) | Sig. | |
|---|---|---|---|---|---|---|
| Age | 18–30 years | 26 (38.2) | 42 (61.8) | 0.891 | 0.864 (0.061–12.225) | 0.914 |
| 31–40 years | 12 (42.9) | 16 (57.1) | 0.605 | 1.522 (0.208–11.12) | 0.679 | |
| Over 40 years | 5 (33.3) | 10 (66.7) | 0.779* | . | . | |
| Sexe | Female | 27 (34.6) | 51 (65.4) | 0.170 | 0.786 (0.262–2.351) | 0.666 |
| Male | 16 (48.5) | 17 (51.5) | . | . | ||
| Marital Status | Married | 17 (38.6) | 27 (61.4) | 0.986 | 1.62 (0.479–5.478) | 0.438 |
| Single | 26 (38.8) | 41 (61.2) | . | . | ||
| Residence | Rural | 2 (20) | 8 (80) | 0.311* | 0.283 (0.043–1.875) | 0.191 |
| Urban | 41 (40.6) | 60 (59.4) | . | . | ||
| Occupation | Physician/Pharmacist | 22 (41.5) | 31 (58.5) | 0.567 | 1.203 (0.147–9.821) | 0.863 |
| Paramedics | 9 (36) | 16 (64) | 0.819* | 1.221 (0.111–13.368) | 0.87 | |
| Students | 10 (38.5) | 16 (61.5) | 0.974 | 0.966 (0.083–11.201) | 0.978 | |
| Others | 2 (28.6) | 5 (71.4) | 0.704* | . | . | |
| Professional experience | Less than 2 years | 12 (66.7) | 6 (33.3) | 0.015* | 3.017 (0.553–16.455) | 0.202 |
| 2–5 years | 9 (32.1) | 19 (67.9) | 0.503* | 0.577 (0.112–2.975) | 0.511 | |
| 6–10 years | 5 (33.3) | 10 (66.6) | 0.779* | 0.343 (0.038–3.11) | 0.341 | |
| More than 10 years | 6 (31.6) | 13 (68.4) | 0.608* | 0.127 (0.009–1.701) | 0.119 | |
| Without | 11 (35.5) | 20 (64.5) | 0.661 | . | . | |
| Sector | Private | 5 (38.5) | 8 (61.5) | 1* | 0.54 (0.102–2.848) | 0.468 |
| Public | 38(38.8) | 60 (61.2) | . | . | ||
| Working place | Out of prvince | 18 (40) | 27 (60) | 0.822 | 0.802 (0.262–2.459) | 0.7 |
| Province | 25 (37.9) | 41 (62.1) | . | . | ||
| Attended regional conferences | Yes | 20 (40) | 30 (60) | 0.805 | 0.816 (0.254–2.616) | 0.732 |
| No | 23 (37.7) | 38 (62.3) | . | . | ||
| Attended national conferences | Yes | 17 (47.2) | 19 (52.8) | 0.204 | 1.834 (0.539–6.248) | 0.332 |
| No | 26 (34.7) | 49 (65.3) | . | . | ||
| Attended international conferences | Yes | 9 (47.4) | 10 (52.6) | 0.444* | 1.487 (0.374–5.908) | 0.573 |
| No | 34 (37) | 58 (63) | . | . | ||
| Influenza vaccine uptake | Yes | 18 (48.6) | 19 (52.4) | 0.130 | 1.86 (0.642–5.389) | 0.253 |
| No | 25 (33.8) | 49 (66.2) | . | . | ||
| COVID-19 vaccine uptake | Yes | 31 (56.4) | 24 (43.6) | 0.000 | 5.484 (1.919–15.675) | 0.001 |
| No | 12 (21.4) | 44 (78.6) | . | . | ||
| Level of knowledge | High | 24 (34.3) | 46 (65.7) | 0.208 | 0.46 (0.139–1.527) | 0.205 |
| Low | 19 (46.3) | 22 (53.7) | . | . |
Data were analyzed using Chi-squared and Fisher (*) tests. Bold character indicates results with a significance difference (Sig.≤ 0.05).
Discussion
The current study was conducted to evaluate the level of knowledge of Algerian healthcare workers about HMPX and their attitude toward its vaccination. To the best of our knowledge this is the first study reporting HMPX knowledge among healthcare workers in Algeria so far.
In fact, healthcare workers are a key group in combating health threats and especially following the emergence of new infectious agents.7 Thus, describing their level of knowledge and awareness especially in the initial steps is very helpful to estimate their preparedness to provide a proper response and sensitize the general population.
Overall, healthcare workers in this study have shown a medium level of knowledge (64.9% of correct responses). These results seemed to be unsatisfactory and the same observation was reported among different healthcare workers groups in different countries.7, 8, 9, 10, 11 , 14 Unsurprisingly, the level of knowledge reported in this study was higher when compared to those reported among the general population in Lebanon and in Saudi Arabia.14 , 15 These results make sense if one considers the lack of attention to this disease in non-endemic countries before the current outbreak.10 , 11
Regarding factors associated with higher levels of knowledge, results showed that younger individuals, married and those practicing out of the province town were associated with the highest score of knowledge. If the explanation of the two last parameters is unclear, the higher level of knowledge among younger individuals could be related to the fact that this category past most of its time in social media platforms and thus increasing their probability to face with subjects related to monkeypox increasing thus their curiosity.
In this study, only 37.8% of the asked healthcare workers were in favour of vaccination if recommended for free. This observation is not surprising knowing that a vaccine hesitancy is also common among this category.9 This rate is so far lower than the reported rates among healthcare workers in Italy (58.6%)9 and in Indonesia (96%).12 Additionally, a rate of 50.6% was reported among the general population in Saudi Arabia.16 The only factor of HMPX vaccines was COVID-19 vaccinated people. This could be explained that people who accepted COVID-19 vaccination are less subject to conspiracy theories regarding vaccines.
At last, this study is with limitations which could affect the generalizability of the results to all Algerian healthcare workers. In fact, the online based method of this survey could over-represent or under-represent certain categories and thus could affect directly the level of knowledge and the willingness to get the vaccine. This type of surveys over-represents mostly young healthcare workers who pass generally more time in social media platforms than aged ones and underestimate individuals without access to the internet. These selection biases are mainly due to the fact that the survey was conducted using social media platforms and was not supported or published by any official institution or websites. Another limitation of this study is related to the low number of respondents who answered to the questionnaire. Finally, in the absence of a validated questionnaire to the Algerian context, the questionnaire items were adopted from other languages which could add other biases to this study.
Conclusion
In conclusion this study, despite some limitations related the sample size and the sampling method, has shown some gaps of knowledge about human monkeypox among the studied healthcare workers in Algeria. The level of vaccine acceptance is also very low. Results of this study even they can not be generalized to all healthcare workers, could be used as a blossom for further studies to better understand this topic which could be helpful in the prevention against an eventual emergence of this disease in Algeria.
Human and animal rights
This study protocol was reviewed and approved by the Scientific Committee of the Faculty of natural and Life Sciences, University of Djelfa (Signed by the dean of the Faculty and the President of the Scientific Committee) with the reference number: 25/06/2022.
Informed consent and patient details
All participants provided their informed consent electronically prior to data collection. Participants who declined consent were not allowed to continue the study, and participants could withdraw from the survey at any time based on requirements of the Declaration of Helsinki Ethical principles.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.vacun.2022.11.003.
Appendix A. Supplementary data
Supplementary material
References
- 1.World Health Organization Disease Outbreak News; Multi-country monkeypox outbreak in non-endemic countries. 21 May 2022. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 Last accessed: 27 September. Available from.
- 2.WHO, World Health Organization WHO Director-General’s Statement at the Press Conference Following IHR Emergency Committee Regarding the Multi-Country Outbreak of Monkeypox. https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergencycommittee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022 Last accessed: 25 September 2022. Available from.
- 3.CDC Monkeypox, 2022 Global map & case count. 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html Last accessed: 27 September 2022. Available from.
- 4.Sklenovská N., Van Ranst M. Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans. Front Public Health. 2018;6:241. doi: 10.3389/fpubh.2018.00241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.CDC About Monkeypox. 2022. https://www.cdc.gov/poxvirus/monkeypox/treatment.html Last accessed: 27 September 2022. available from.
- 6.Wilkason C., Lee C., Sauer L.M., Nuzzo J., McClelland A. Assessing and reducing risk to healthcare workers in outbreaks. Health Secur. 2020;18(3):205–211. doi: 10.1089/hs.2019.0131. [DOI] [PubMed] [Google Scholar]
- 7.Sallam M., Al-Mahzoum K., Al-Tammemi A.B., Alkurtas M., Mirzaei F., Kareem N., et al. Assessing Healthcare workers’ knowledge and their confidence in the diagnosis and management of human Monkeypox: a cross-sectional study in a middle eastern country. Healthcare. 2022;10:1722. doi: 10.3390/healthcare10091722. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Alsanafi M., Al-Mahzoum K., Sallam M. Monkeypox knowledge and confidence in diagnosis and management with evaluation of emerging virus infection conspiracies among health professionals in Kuwait. Pathogens. 2022;11:994. doi: 10.3390/pathogens11090994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Riccò M., Ferraro P., Camisa V., Satta E., Zaniboni A., Ranzieri S., et al. When a neglected tropical disease goes global: knowledge, attitudes and practices of italian physicians towards Monkeypox, preliminary results. Trop Med Infect Dis. 2022;7:135. doi: 10.3390/tropicalmed7070135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Harapan H., Setiawan A., Yufika A., Anwar S., Wahyuni S., Asrizal F., et al. Knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in Indonesia. Pathog Glob Health. 2020;114(2):68–75. doi: 10.1080/20477724.2020.1743037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Harapan H., Setiawan A.M., Yufika A., Anwar S., Wahyuni S., Asrizal F.W., et al. Confidence in managing human monkeypox cases in Asia: a cross-sectional survey among general practitioners in Indonesia. Acta Trop. 2020;206 doi: 10.1016/j.actatropica.2020.105450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Harapan H., Wagner A.L., Yufika A., Setiawan A.M., Anwar S., Wahyuni S., et al. Acceptance and willingness to pay for a hypothetical vaccine against monkeypox viral infection among frontline physicians: a cross-sectional study in Indonesia. Vaccine. 2020;38:6800–6806. doi: 10.1016/j.vaccine.2020.08.034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Alshahrani N.Z., Algethami M.R., Alarifi A.M., Alzahrani F., Sheerah H.A., Abdelaal A., et al. Knowledge and attitude regarding monkeypox virus among physicians in Saudi Arabia, a cross-sectional study. Researchsquare [Preprint] 2022 doi: 10.21203/rs.3.rs-1883068/v1. [cited 2022 July 22]; 20p. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Youssef D., Abboud E., Kawthami M., Zheim Z., Abou Arrage N., Youssef J. When a neglected tropical zoonotic disease emerges in non-endemic countries: Need to proactively fill the unveiled knowledge gaps towards human monkeypox among the Lebanese population [Internet] Researchsquare [Preprint] 2022 doi: 10.21203/rs.3.rs-1998212/v1. [cited 2022 Aug 30]; 39p. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Alshahrani N.Z., Alzahrani F., Alarifi A.M., Algethami M.R., Alhumam M.N., Ayied H.A.M., et al. Assessment of knowledge of Monkeypox viral infection among the general population in Saudi Arabia. Pathogens. 2022;11:904. doi: 10.3390/pathogens11080904. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Temsah M.H., Aljamaan F., Alenezi S., Alhasan K., Saddik B., Al-Barag A., et al. Monkeypox caused less worry than COVID-19 among the general population during the first month of the WHO Monkeypox alert: experience from Saudi Arabia. Travel Med Infect Dis. 2022;49 doi: 10.1016/j.tmaid.2022.102426. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Supplementary Materials
Supplementary material