Monkeypox as a potential emerging pandemic: a discussion on future risks and preparedness in Saudi Arabia

Virology, epidemiology, transmissions, diagnostic tests, prophylaxis and treatments of human Mpox: Saudi Arabia perspective

Mpox (Monkeypox) is a highly contagious viral disease that can be transmitted from animal-to-human or human-to-human through intimate contact, Mpox is caused by the monkeypox virus (MPXV), which is an enveloped double-stranded DNA that belongs to the genus Orthopoxvirus, Poxviridae family, and subfamily Chordopoxvirinae. Mpox cases were previously only reported in West and Central Africa, however in recent times non-endemic countries including Saudi Arabia (SA) also reported confirmed Mpox cases. The first laboratory-confirmed human Mpox case in SA was reported on 14 July 2022, since then a number of confirmed Mpox cases have been reported by WHO in SA. These confirmed Mpox cases in SA were observed among individuals with a history of visiting European Union countries. SA is not only at risk of importation of Mpox cases owing to travel to such countries, but also there are various other risk factors including geographic proximity to the African continent, trade in exotic animals, and massive inflow of tourists. Therefore, government health authorities of SA should continue to collaborate with various international health organizations including WHO to prevent, manage or monitor potential health risks at most of the entry points in SA including highways, seaports, and airports by ensuring adherence to hygiene protocols, vaccinations, and health screenings. There are a range of diagnostic tests are currently available that can be used in SA to confirm Mpox infections, including real-time PCR, loop-mediated isothermal amplification, serological testing, clustered regularly interspaced short palindromic repeat-CRISPR-associated protein (CRISPR-Cas)-based systems, whole-genome sequencing, electron microscopy, and virus isolation and culture. There is no approved treatment specifically for Mpox, however multiple approved antiviral agents for smallpox treatment were found to be useful in Mpox treatment and in the management of Mpox outbreaks, such as- trifluridine, brincidofovir, tecovirimat, and cidofovir. The aim of this review is to provide valuable insights regarding virology, pathogenesis, epidemiology, transmissions, clinical presentation, diagnostic tests, prophylactic measures and therapeutic options of Mpox from SA perspective. Moreover, a side-by-side discussion on the global trend and scenarios of Mpox has been provided for comparison and further improvement in measures against Mpox in SA.

Knowledge, Attitude and Associated Factors of Monkeypox Infection Among Healthcare Workers in Injibara General Hospital, Northwest Ethiopia

Background

Fighting health threats, especially the rise of new infectious diseases, is one of the main responsibilities of healthcare workers. However, their knowledge and attitudes toward monkeypox have not yet been assessed. Therefore, this study aimed to assess the knowledge, attitude, and factors associated with monkeypox infection among healthcare workers at Injibara General Hospital, Northwest Ethiopia.

Methods

Institution-based cross-sectional study was conducted from December 1-30, 2022. Data were collected using a structured self-administered questionnaire. A simple random sampling technique was used to select study participants. Descriptive statistics and multivariable logistic regression analyses were computed. The degree of association was interpreted using an odds ratio with a 95% confidence interval and a p-value < 0.05.

Results

Among the 200 healthcare workers who participated, 38.5% (95% CI: 32.5%-45%) and 62% (95% CI: 55-68.5%) had good knowledge and positive attitudes regarding monkeypox respectively. Having a master's degree or above (AOR = 11.25: 95% CI: 2.03-62.33), being vaccinated against COVID-19 (AOR = 2.60: 95% CI: 1.37-4.94), and having access to information about monkeypox (AOR = 3.37: 95% CI: 1.33-8.50) were the factors associated with good knowledge. Furthermore, a positive attitude was significantly associated with being 30 years of age or older (AOR = 2.95: 95% CI: 1.55-5.60) and having access to information about monkeypox (AOR = 4.14: 95% CI: 2.06, 8.30).

Conclusion

Both good knowledge and positive attitudes were relatively low among healthcare workers. Factors such as age, education level, COVID-19 vaccination status, and access to information about monkeypox were significantly associated with the knowledge and attitude of healthcare workers. To enhance the knowledge and attitude of healthcare workers, hospitals should consider offering educational upgrades, hosting educational events like seminars, conferences, webinars, and campaigns, and ensuring comprehensive coverage of the topic in medical curricula.