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.

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Health Sciences Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Public Health Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Institute of Health Information and Statistics of the Czech Republic 128 01 Prague Czech Republic

See more in PubMed

Centers for Disease Control and Prevention (CDC) Travel. [(accessed on 21 October 2022)]; Available online: https://www.cdc.gov/poxvirus/monkeypox/travel/index.html.

WHO Monkeypox. [(accessed on 21 May 2022)]. Available online: https://www.who.int/news-room/fact-sheets/detail/monkeypox.

ECDC Epidemiological Update: Monkeypox Outbreak. [(accessed on 22 May 2022)]; Available online: https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak.

World Health Organization (WHO) Vaccines and Immunization for Monkeypox: Interim Guidance. [(accessed on 10 August 2022)]; Available online: https://www.who.int/publications/i/item/who-mpx-immunization-2022.1.

Centers for Disease Control and Prevention (CDC) 2022 Monkeypox Outbreak Global Map. [(accessed on 10 August 2022)]; Available online: https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.

CDC Transmission. [(accessed on 22 May 2022)]; Available online: https://www.cdc.gov/poxvirus/monkeypox/transmission.html.

Bass J., Tack D.M., McCollum A.M., Kabamba J., Pakuta E., Malekani J., Nguete B., Monroe B.P., Doty J.B., Karhemere S., et al. Enhancing Health Care Worker Ability to Detect and Care for Patients with Monkeypox in the Democratic Republic of the Congo. Int. Health. 2013;5:237–243. doi: 10.1093/inthealth/iht029. PubMed DOI PMC

Harapan H., Setiawan A.M., Yufika A., Anwar S., Wahyuni S., Asrizal F.W., Sufri M.R., Putra R.P., Wijayanti N.P., Salwiyadi S., et al. Knowledge of Human Monkeypox Viral Infection among General Practitioners: A Cross-Sectional Study in Indonesia. Pathog. Glob. Health. 2020;114:68–75. doi: 10.1080/20477724.2020.1743037. PubMed DOI PMC

WHO . WHO Advisory Committee on Variola Virus Research Report of the Nineteenth Meeting, 1–2 November 2017. WHO; Geneva, Switzerland: 2018.

Ammar N., Aly N.M., Folayan M.O., Mohebbi S.Z., Attia S., Howaldt H.P., Boettger S., Khader Y., Maharani D.A., Rahardjo A., et al. Knowledge of Dental Academics about the COVID-19 Pandemic: A Multi-Country Online Survey. BMC Med. Educ. 2020;20:399. doi: 10.1186/s12909-020-02308-w. PubMed DOI PMC

Von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. UroToday Int. J. 2007;335:806–808. doi: 10.1097/EDE.0b013e3181577654. PubMed DOI PMC

Harvard Humanitarian Initiative Welcome to KoBoToolbox. [(accessed on 4 January 2022)]. Available online: https://support.kobotoolbox.org/welcome.html.

Ministerstvo Zdravotnictví ČR Úroveň Informovanosti a Vnímání Lidských Opičích Neštovic Českými Zdravotnickými Profesionály. [(accessed on 11 October 2022)]. Available online: https://www.mzcr.cz/uroven-informovanosti-a-vnimani-lidskych-opicich-nestovic-ceskymi-zdravotnickymi-profesionaly/

Andrea Pokorná Úroveň Informovanosti a Vnímání Lidských Opičích Neštovic Českými Zdravotnickými Profesionály. [(accessed on 11 October 2022)]. Available online: https://uzv.med.muni.cz/o-pracovisti/aktuality/uroven-informovanosti-a-vnimani-lidskych-opicich-nestovic-ceskymi-zdravotnickymi-profesionaly.

Institute of Health Information and Statistics of the Czech Republic (UZIS) [Health Yearbook of the Czech Republic 2017] [(accessed on 3 March 2021)]. Available online: https://www.uzis.cz/index-en.php?pg=record&id=8166.

Aljamaan F., Alenezi S., Alhasan K., Saddik B., Alhaboob A., Altawil E.S., Alshahrani F., Alrabiaah A., Alaraj A., Alkriadees K., et al. Healthcare Workers’ Worries and Monkeypox Vaccine Advocacy during the First Month of the WHO Monkeypox Alert: Cross-Sectional Survey in Saudi Arabia. Vaccines. 2022;10:1408. doi: 10.3390/vaccines10091408. PubMed DOI PMC

Riccò M., Ferraro P., Camisa V., Satta E., Zaniboni A., Ranzieri S., Baldassarre A., Zaffina S., Marchesi F. 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. PubMed DOI PMC

Harapan H., Setiawan A.M., Yufika A., Anwar S., Wahyuni S., Asrizal F.W., Sufri M.R., Putra R.P., Wijayanti N.P., Salwiyadi S., et al. Physicians’ Willingness to Be Vaccinated with a Smallpox Vaccine to Prevent Monkeypox Viral Infection: A Cross-Sectional Study in Indonesia. Clin. Epidemiol. Glob. Health. 2020;8:1259–1263. doi: 10.1016/j.cegh.2020.04.024. PubMed DOI PMC

High Acceptance of New Monkeypox Vaccine among GPs in Indonesia. Pharm. Outcomes News. 2020;862:15. doi: 10.1007/s40274-020-7133-6. DOI

Harapan H., Wagner A.L., Yufika A., Setiawan A.M., Anwar S., Wahyuni S., Asrizal F.W., Sufri M.R., Putra R.P., Wijayanti N.P., 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. PubMed DOI PMC

World Medical Association World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA J. Am. Med. Assoc. 2013;310:2191–2194. doi: 10.1001/jama.2013.281053. PubMed DOI

Proton Technologies AG General Data Protection Regulation (GDPR) Compliance Guidelines. [(accessed on 1 May 2020)]. Available online: https://gdpr.eu/

SPSS Inc. IBM SPSS Statistics 28. [(accessed on 14 March 2021)]. Available online: https://www.ibm.com/support/pages/ibm-spss-statistics-28-documentation.

The Jamovi Project Jamovi (Version 1.6) [Computer Software] [(accessed on 11 February 2022)]. Available online: https://www.jamovi.org.

Zucman D., Fourn E., Touche P., Majerholc C., Vallée A. Monkeypox Vaccine Hesitancy in French Men Having Sex with Men with PrEP or Living with HIV in France. Vaccines. 2022;10:1629. doi: 10.3390/vaccines10101629. PubMed DOI PMC

Malik A.A., Winters M.S., Omer S.B. Attitudes of the US General Public towards Monkeypox. medRxiv. 2022 doi: 10.1101/2022.06.20.22276527. PubMed DOI PMC

Htm Dukers-Muijrers N., Evers Y., Widdershoven V., Davidovich U., Adam P.C., Lm E., de Coul O., Zantkuijl P., Matser A., Prins M., et al. Monkeypox Vaccination Willingness, Determinants, and Communication Needs in Gay, Bisexual, and Other Men Who Have Sex with Men, in the Context of Limited Vaccine Availability in the Netherlands (Dutch MPX-Survey) medRxiv. 2022 doi: 10.1101/2022.10.11.22280965. PubMed DOI PMC

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. PubMed DOI PMC

Sallam M., Al-Mahzoum K., Al-Tammemi A.B., Alkurtas M., Mirzaei F., Kareem N., Al-Naimat H., Jardaneh L., Al-Majali L., AlHadidi A., 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. PubMed DOI PMC

Temsah M.H., Aljamaan F., Alenezi S., Alhasan K., Saddik B., Al-Barag A., Alhaboob A., Bahabri N., Alshahrani F., Alrabiaah 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;49:102426. doi: 10.1016/j.tmaid.2022.102426. PubMed DOI PMC

Alshahrani N.Z., Alzahrani F., Alarifi A.M., Algethami M.R., Alhumam M.N., Ayied H.A.M., Awan A.Z., Almutairi A.F., Bamakhrama S.A., Almushari B.S., et al. Assessment of Knowledge of Monkeypox Viral Infection among the General Population in Saudi Arabia. Pathogens. 2022;11:904. doi: 10.3390/pathogens11080904. PubMed DOI PMC

Ahmed S.K., Abdulqadirb S.O., Omar R.M., Hussein S.H., M-Amin H.I., Chandran D., Sharma A.K., Dhama K., Ahmed Z.K., Essa R.A., et al. Study of Knowledge, Attitude and Anxiety in Kurdistan-Region of Iraqi Population during the Monkeypox Outbreak in 2022. 2022. [(accessed on 11 February 2022)]. Available online: DOI

Alshahrani N.Z., Mitra S., Alkuwaiti A.A., Alhumam M.N., Altmimi S.M.B., Alamri M.H.M., Albalawi Z.A.S., Almorgi M.W., Alharbi H.K.D., Alshahrani S.M. Medical Students’ Perception Regarding the Re-Emerging Monkeypox Virus: An Institution-Based Cross-Sectional Study from Saudi Arabia. Cureus. 2022;14:e28060. doi: 10.7759/cureus.28060. PubMed DOI PMC

Baker I., Marzouqa N., Yaghi B.N., Adawi S.O., Yousef S., Sabooh T.N., Salhab N.M., Khrishi H.M., Qabaja Y., Riad A., et al. The Impact of Information Sources on COVID-19-Related Knowledge, Attitudes, and Practices (KAP) among University Students: A Nationwide Cross-Sectional Study. Int. J. Environ. Res. Public Health. 2021;18:12462. doi: 10.3390/ijerph182312462. PubMed DOI PMC

Alawia R., Riad A., Kateeb E. Knowledge and Attitudes among Dental Students about COVID-19 and Its Precautionary Measures: A Cross-Sectional Study. J. Oral Med. Oral Surg. 2021;27:17. doi: 10.1051/mbcb/2020056. DOI

Alawia R., Riad A., Kateeb E. Risk Perception and Readiness of Dental Students to Treat Patients amid COVID-19: Implication for Dental Education. Oral Dis. 2020;28:975–976. doi: 10.1111/odi.13593. PubMed DOI PMC

Dosedel M., Hendrychova T., Maly J., Kubena A., Byma S., Vlcek J. Prescription of Evidence-Based Medicine Drugs by General Practitioners to Patients after Myocardial Infarction: Outcomes from the Czech Republic. Acta Pol. Pharm. Drug Res. 2014;71:189–195. PubMed

Carter M., Strnadová I., Stephenson J. Reported Prevalence of Evidence-Based Instructional Practices by Special Educators in the Czech Republic. Eur. J. Spec. Needs Educ. 2012;27:319–335. doi: 10.1080/08856257.2012.691229. DOI

Vrbová T., Klugarová J., Pokorná A., Dušek L., Líčeník R., Klugar M. Enhancing the Evidence-Based Healthcare Principles in Clinical Practice Guidelines Development in the Czech Republic: A Best Practice Implementation Project. Int. J. Evid. Based Healthc. 2022;20:S67–S75. doi: 10.1097/XEB.0000000000000337. PubMed DOI

Fridman I., Lucas N., Henke D., Zigler C.K. Association Between Public Knowledge About COVID-19, Trust in Information Sources, and Adherence to Social Distancing: Cross-Sectional Survey. JMIR Public Health Surveill. 2020;6:e22060. doi: 10.2196/22060. PubMed DOI PMC

Lipkus I.M., Eissenberg T., Schwartz-Bloom R.D., Prokhorov A.V., Levy J. Relationships among Factual and Perceived Knowledge of Harms of Waterpipe Tobacco, Perceived Risk, and Desire to Quit among College Users. J. Health Psychol. 2013;19:1525–1535. doi: 10.1177/1359105313494926. PubMed DOI PMC

El-Deirawi K.M., Zuraikat N. Registered Nurses’ Actual and Perceived Knowledge of Diabetes Mellitus. J. Nurses Staff. Dev. 2001;17:5–11. doi: 10.1097/00124645-200101000-00001. PubMed DOI

Alotaibi A., Gholizadeh L., Al-Ganmi A., Perry L. Examining Perceived and Actual Diabetes Knowledge among Nurses Working in a Tertiary Hospital. Appl. Nurs. Res. 2017;35:24–29. doi: 10.1016/j.apnr.2017.02.014. PubMed DOI

Drass J.A., Muir-Nash J., Boykin P.C., Turek J.M., Baker K.L. Perceived and Actual Level of Knowledge of Diabetes Mellitus among Nurses. Diabetes Care. 1989;12:351–356. doi: 10.2337/diacare.12.5.351. PubMed DOI

Baxley S.G., Brown S.T., Pokorny M.E., Swanson M.S. Perceived Competence and Actual Level of Knowledge of Diabetes Mellitus among Nurses. J. Nurs. Staff Dev. 1997;13:93–98. PubMed

Rouse D.M., Tynan A. Actual and Perceived Knowledge of Research Ethics Guidelines in a Sample of Public Health Clinicians. Intern. Med. J. 2021;51:1840–1846. doi: 10.1111/imj.14984. PubMed DOI

Park C.-Y. News Media Exposure and Self-Perceived Knowledge: The Illusion of Knowing. Int. J. Public Opin. Res. 2001;13:419–425. doi: 10.1093/ijpor/13.4.419. DOI

Ladwig P., Dalrymple K.E., Brossard D., Scheufele D.A., Corley E.A. Perceived Familiarity or Factual Knowledge? Comparing Operationalizations of Scientific Understanding. Sci. Public Policy. 2012;39:761–774. doi: 10.1093/scipol/scs048. DOI

D’Antonio F., Pagani G., Buca D., Khalil A. Monkeypox Infection in Pregnancy: A Systematic Review and Metaanalysis. Am. J. Obstet. Gynecol. MFM. 2023;5:100747. doi: 10.1016/j.ajogmf.2022.100747. PubMed DOI PMC

Wong M.C.S., Wong E.L.Y., Huang J., Cheung A.W.L., Law K., Chong M.K.C., Ng R.W.Y., Lai C.K.C., Boon S.S., Lau J.T.F., et al. Acceptance of the COVID-19 Vaccine Based on the Health Belief Model: A Population-Based Survey in Hong Kong. Vaccine. 2021;39:1148–1156. doi: 10.1016/j.vaccine.2020.12.083. PubMed DOI PMC

Tao L., Wang R., Han N., Liu J., Yuan C., Deng L., Han C., Sun F., Liu M., Liu J. Acceptance of a COVID-19 Vaccine and Associated Factors among Pregnant Women in China: A Multi-Center Cross-Sectional Study Based on Health Belief Model. Hum. Vaccines Immunother. 2021;17:2378–2388. doi: 10.1080/21645515.2021.1892432. PubMed DOI PMC

Yu Y., Lau J.T.F., She R., Chen X., Li L., Li L., Chen X. Prevalence and Associated Factors of Intention of COVID-19 Vaccination among Healthcare Workers in China: Application of the Health Belief Model. Hum. Vaccines Immunother. 2021;17:2894–2902. doi: 10.1080/21645515.2021.1909327. PubMed DOI PMC

Klugar M., Riad A., Mohanan L., Pokorná A. COVID-19 Vaccine Booster Hesitancy (VBH) of Healthcare Workers in Czechia: National Cross-Sectional Study. Vaccines. 2021;9:1437. doi: 10.3390/vaccines9121437. PubMed DOI PMC

Attia S., Mausbach K., Klugar M., Howaldt H.-P., Riad A. Prevalence and Drivers of COVID-19 Vaccine Booster Hesitancy (VBH) among German University Students and Employees. Front. Public Health. 2022;10:846861. doi: 10.3389/fpubh.2022.846861. PubMed DOI PMC

Dziedzic A., Issa J., Hussain S., Tanasiewicz M., Wojtyczka R., Kubina R., Konwinska M.D., Riad A. COVID-19 Vaccine Booster Hesitancy (VBH) of Healthcare Professionals and Students in Poland: Cross-Sectional Survey-Based Study. Front. Public Health. 2022;10:2391. doi: 10.3389/fpubh.2022.938067. PubMed DOI PMC

Lounis M., Bencherit D., Rais M.A., Riad A. COVID-19 Vaccine Booster Hesitancy (VBH) and Its Drivers in Algeria: National Cross-Sectional Survey-Based Study. Vaccines. 2022;10:621. doi: 10.3390/vaccines10040621. PubMed DOI PMC

Larson H., de Figueiredo A., Karafllakis E., Rawal M. State of Vaccine Confidence in the European Union in 2018. Eur. J. Public Health. 2019;29:ckz185-374. doi: 10.1093/eurpub/ckz185.374. DOI

Wayne W. LaMorte The Health Belief Model. [(accessed on 11 August 2022)]. Available online: https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories2.html.

Rosenstock I.M. The Health Belief Model and Preventive Health Behavior. Health Educ. Behav. 1974;2:354–386. doi: 10.1177/109019817400200405. DOI

The Czech Statistical Office (CZSO) Health Care Personnel as at 31 December. [(accessed on 21 October 2022)]; Available online: https://www.czso.cz/documents/10180/120583268/300002200201.pdf/

Belarusian Healthcare Professionals' Views on Monkeypox and Vaccine Hesitancy

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