Study: Experiences and perceptions of international healthcare professionals regarding the mpox epidemic in several countries in 2022. Image Credit: Crown Studio/Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behavior, or be treated as established information.
A survey was recently conducted to understand the experiences and perceptions of multinational healthcare professionals during recent mpox outbreaks around the world.
The study is currently available on medRxiv preprint server*.
Background
Health workers play an important role in health system preparedness and resilience during public health emergencies. Coronavirus disease 2019 (COVID-19) has shown the world how severely a pandemic can impact the health and well-being of healthcare workers.
During a pandemic like COVID-19, frontline healthcare workers face major challenges in providing necessary services to people affected by a disease whose clinical course and prognostic factors are largely unknown . They also face uncertainty, anxiety, stress, fear of contracting illness, lack of personal protective equipment and extended work hours.
Real-world studies have reported widely varying experiences of adversity, moral distress, and resilience among healthcare workers during the COVID-19 pandemic. International knowledge exchange and transfer programs have been found to partially alleviate the challenges faced by healthcare workers during the pandemic.
The global outbreaks of monkeypox (mpox) from 2022 to 2023 have had a significant impact on healthcare professionals, particularly those residing in non-endemic countries such as Europe and the United States. The emergence of mpox outside of historically affected regions has posed new challenges, particularly in the context of ongoing global health crises such as COVID-19. Most of the challenges faced by healthcare workers are associated with a lack of knowledge and experience about the disease.
In this study, an international team of scientists examined the personal and clinical experiences of healthcare workers from several countries during mpox outbreaks.
Study design
This investigation was conducted between August and October 2022 among health workers involved in the clinical management of mpox epidemics. A total of 725 multinational healthcare professionals from 41 non-endemic countries were enrolled in the survey.
Self-reported data on clinical workload, safety, preparedness, workplace training and support, mental well-being and vaccination were collected using online questionnaires. The emergence of mpox outside of historically affected regions has posed new challenges, particularly in the context of ongoing global health crises such as COVID-19.
Important observations
Healthcare professionals from the United Kingdom, European Union, Caribbean, Central America, South America, United States and Canada participated in this survey.
About 91% of participants were doctors specializing in sexual health or infectious diseases, and 34% were involved in mpox policy.
Approximately 41% of participants reported longer work hours during the mpox outbreak, and 87% reported having to deal with this additional burden alongside their usual clinical responsibilities. This additional workload, without removing existing responsibilities, has exacerbated the pressure on health systems already strained by the ongoing pandemic.
About 30% of participants reported having no knowledge about mpox before the outbreak, and only 1% reported having experience treating a case of mpox before the outbreak. This highlights the significant lack of knowledge among healthcare professionals about re-emerging diseases, a major concern given the increasing frequency of such outbreaks.
More than 25% of participants reported initially misdiagnosing someone with a mpox-related rash with another illness. The most frequently reported diagnostic errors were varicellasyphilis and herpes.
More than half of the study population agreed that their institutions provided clear, timely, and authoritative information about the disease and that they had received the required education, training, or instruction. However, there are notable regional disparities, with healthcare workers in the Caribbean, Central and South America reporting significantly less institutional support than their counterparts in Europe and North America .
About 60% and 72% of participants reported following local department guidelines and national guidelines, respectively. Approximately 40% of participants expressed dissatisfaction with the support received from national public health agencies. This discontent was particularly pronounced in regions with historically limited access to public health resources, highlighting the need for more equitable support structures.
More than half of the study population reported feeling moral distress due to their professional experience managing suspected or confirmed clinical cases of mpox. Approximately 37% of participants reported impaired psychological well-being due to moral distress.
The study results highlight the significant psychological impact on healthcare workers, which could have long-term consequences for the sustainability of the workforce.
Vaccination to prevent mpox
Less than 50% of participants reported being vaccinated against smallpox before the mpox outbreak. In the United States, Europe and Canada, about one in three participants received the vaccine, while the vaccination rate was one in ten in the Caribbean, Central and South America.
Overall, the vaccination rate was high in all regions studied. More than 90% of participants in each region said vaccination should be offered to people at high risk of mpox infection before exposure.
Despite this strong acceptance, the survey found significant inequities in vaccine access, particularly in low-resource settings, which reflected challenges faced during the COVID-19 pandemic.
Significance of the study
This multinational survey reveals a profound lack of knowledge about mpox among healthcare professionals, even though this neglected disease has been circulating among humans since 1970.
Such a knowledge gap highlights the urgent need to increase global pandemic preparedness initiatives for frontline healthcare workers.
The findings suggest that health systems must prioritize education and training of health workers on emerging infectious diseases to ensure rapid and effective responses to future outbreaks.
The survey reveals a high level of acceptance and use of the vaccine among health professionals involved in the management of suspected or confirmed cases of mpox. However, inequalities and access to vaccines are high in the Caribbean, Central and South America. This inequity hinders effective responses to outbreaks in these regions and raises concerns about the overall equity and effectiveness of global health interventions.
Such inequity highlights the need to prioritize health workers for mpox vaccination, particularly in regions with few infection prevention resources. The study calls for a coordinated global effort to address these disparities and ensure that healthcare workers, particularly in low-resource settings, are adequately protected. The scientists mentioned that similar surveys should be conducted among African clinicians to understand how unavailability or inaccessibility to essential resources such as vaccines affects their psychological well-being and perception of support.
Overall, the survey results highlight the critical need to strengthen the resilience of global health systems and multidisciplinary approaches against future outbreaks. This resilience building must include addressing systemic issues leading to burnout and moral distress among health professionals, ensuring that the global health workforce is prepared and supported in the face of future public health emergencies.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behavior, or be treated as established information.