When a Neglected Tropical Disease Goes Global: Knowledge, Attitudes and Practices of Italian Physicians towards Monkeypox, Preliminary Results
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Questionnaire
- Main demographic data: age, gender, seniority as medical professional, medical background (i.e., working as OP, PH, GP, or other medical professional); the Italian region where the professional mainly worked and lived.
- Knowledge Test. Participants received a total of 24 statements on MPX (e.g., “Typically, one out of 3 women is affected by migraine”; TRUE). A summary score (Knowledge Score; KS) was then calculated by adding +1 to a sum score for every correct answer, whereas a wrong indication or a missing/“don’t know” answer added 0 to the sum score (potential range 0 to 24).
- Risk perception. Participants were requested to rate the perceived severity (CMPX) and the perceived frequency (FMPX) of MPX in Italian population by means of a fully labeled 5-point Likert scale (range: from “not significant” to “very significant”). According to Yates [49], perceived risk can be defined as a function of the perceived probability of an event and its expected consequences, and a Risk Perception Score (RPS) was therefore calculated as the product of CMPX and FMPX (potential range 1 to 25).
- Attitudes and Practices. The attitude towards VARV vaccine in order to prevent MPX infection was initially inquired, focusing on both the personal acceptance and the use in the general population. Both attitudes were reported in a full scale of 1 (totally disagree) to 5 (totally agree). Medical professionals were then requested to similarly rate how important they perceived the capability of the vaccine to avoid natural infection and complications, and about their willingness to pay, both as a personal expense (i.e., how much they would accept to pay for a MPX vaccine), and from a Public Health point of view (i.e., the optimal price for a MPX vaccine). Respondents were then requested to rate through a full Likert scale 1 (totally disagree) to 5 (totally agree) whether they perceived or not MPX as a likely occurrence during daily activities in the following months, whether they perceived or not MPX as potentially affecting daily working activities, and whether they were confident of not to be able to recognize a MPX case. Respondents were then asked to rate how difficult they perceived the management of different infectious diseases in the Italian settings, and more precisely: MPX, seasonal influenza virus (SIV), SARS-CoV-2, Hepatitis B virus (HBV), tuberculosis (TB), Human Immunodeficiency Virus (HIV). All of the aforementioned disorders were rated 1 (not difficult) to 10 (very difficult). Eventually, participants were requested to report whether they had received or not VARV vaccine (vaccination mandate for all Italian newborns was enforced until 1977, then suspended and eventually abolished in 1981), SIV vaccine during previous influenza season (i.e., 2021), and SARS-CoV-2 vaccine (at least 2 doses).
2.3. Ethical Considerations
2.4. Data Analysis
3. Results
3.1. Descriptive Analysis
3.2. Knowledge Test
3.3. Risk Perception
3.4. Attitudes and Practices towards MPX Vaccination
3.5. Univariate Analysis
3.6. Multivariable Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable | Respondents | p-Value | |
---|---|---|---|
Included in the Analyses (No./163, %) | Not Included in the Analyses (No./283, %) | ||
Male Gender | 57, 35.0% | 92, 32.5% | 0.670 |
Age (years; average ± SD) | 42.9 ± 10.0 | 42.3 ± 9.8 | 0.512 |
Seniority (years; average ± SD) | 16.3 ± 10.3 | 15.7 ± 9.9 | 0.593 |
Living in … | 0.795 | ||
Northern Italy 1 | 90, 55.2% | 154, 54.4% | |
Central Italy 2 | 41, 25.2% | 63, 22.3% | |
Southern Italy/Islands 3 | 28, 17.2% | 58, 20.5% | |
Other EU country | 4, 2.4% | 8, 2.8% | |
Knowledge Score (%; average ± SD) | 51.8 ± 13.9 | 50.9 ± 13.9 | 0.560 |
Risk Perception Score (%; average ± SD) | 22.3 ± 14.6 | 22.6 ± 14.5 | 0.834 |
Perceived Burden (0 to 10, average ± SD) | 5.4 ± 2.2 | 5.6 ± 2.1 | 0.342 |
Favorable/Highly favorable to using smallpox vaccination against MPX | 96, 58.9% | 177, 62.5% | 0.446 |
Favorable/Highly favorable to receive smallpox vaccination against MPX | 105, 64.4% | 191, 64.0% | 0.508 |
Group | Knowledge Score (%) | Perceived Burden (0 to 10) | Risk Perception Score (%) | |||
---|---|---|---|---|---|---|
Average ± SD | p-Value | Average ± SD | p-Value | Average ± SD | p-Value | |
Occupational Physicians | 50.0 ± 15.9 | 0.404 | 23.1 ± 15.5 | 0.509 | 5.6 ± 2.3 | 0.413 |
General Practitioners | 52.3 ± 11.6 | 0.914 | 23.1 ± 15.2 | 0.464 | 5.5 ± 2.2 | 0.498 |
Public Health professionals | 53.2 ± 11.4 | REF. | 20.1 ± 12.4 | REF. | 5.1 ± 2.0 | REF. |
Total | 51.8 ± 13.0 | - | 22.3 ± 14.6 | - | 5.4 ± 2.2 | - |
Statement | Correct Answer | Total (No./163) |
---|---|---|
MPX is caused by a newly discovered virus | FALSE | 154, 95.1% |
MPX virus circulates only among primates, including humans | FALSE | 72, 44.4% |
In most cases, MPX evolves in an uncomplicated influenza-like illness | FALSE | 79, 48.5% |
MPX infections are associated with typical skin lesions | TRUE | 140, 85.9% |
Asymptomatic individuals are critical in circulating MPX | FALSE | 50, 24.7% |
Until recently, European cases of MPX have been mostly travel-associated | TRUE | 134, 82.2% |
An effective vaccine against MPX is to date available | TRUE | 98, 60.1% |
Effective drugs targeting MPX virus are to date available | TRUE | 83, 51.2% |
Recipients of VARV vaccine do not need further vaccination shots to be protected against MPX | FALSE | 53, 32.5% |
MPX may be transmitted … | ||
… through the respiratory system | FALSE | 0, - |
… through respiratory droplets | FALSE | 2, 1.2% |
… through direct contagion | FALSE | 16, 9.8% |
… through body fluids | FALSE | 17, 10.4% |
… all of the above | TRUE | 128, 78.5% |
Don’t know | ||
The case-fatality ratio of MPX usually ranges between… | ||
… 4% and 11% | TRUE | 118, 72.4% |
… 14% and 19% | FALSE | 11, 6.7% |
… 20% and 30% | FALSE | 2, 1.2% |
… 30% and 40% | FALSE | 5, 3.1% |
Don’t know | - | 27, 16.6% |
Globally, MPX in the last decade has caused around … | ||
… 1000 cases or less | FALSE | 46, 28.4% |
… 1000 to 10,000 cases | FALSE | 61, 37.7% |
… 10,000 cases or more | TRUE | 20, 12.3% |
Don’t know | - | 35, 22.2% |
MPX infection is associated with a high rate of systemic complications | TRUE | 34, 20.9% |
MPX causes a less severe illness in children (age < 14 y.o.) than in adults | FALSE | 56, 34.4% |
MPX infection is usually associated with a … lymphadenopathy. | ||
… typical, cervical and/or inguinal … | TRUE | 94, 57.7% |
… typical, in axillary and/or groin nodes … | FALSE | 34, 20.9% |
… not noticeable | FALSE | 9, 5.5% |
Don’t know | - | 26, 16.0% |
The skin rash associated with MPX is typically asynchronous | FALSE | 46, 28.2% |
Surface extension and profusion of MPX-associated skin lesions are of prognostic value | TRUE | 70, 42.9% |
MPX-associated skin lesions may be differentially diagnosed as … according to their stage | ||
Varicella/Varicella-Zoster | FALSE | 23, 14.2% |
Typhus | FALSE | 2, 1.2% |
Molluscum contagiosum/water warts | FALSE | 5, 3.1% |
Syphilis | FALSE | 0, - |
Herpes simplex | FALSE | 0, - |
All of the above | TRUE | 132, 81.5% |
Standard preventive measures are effective in preventing MPX infection | TRUE | 122, 74.8% |
A clinical case characterized by: (1) atypical skin rash; (2) lymphadenopathy (cervical and/or inguinal); (3) history of travel to countries endemic for MPX | ||
Confirmed MPX case | FALSE | 9, 5.5% |
Probable MPX case | TRUE | 127, 77,9% |
Doubtful MPX case | FALSE | 23, 14.1% |
Don’t know | - | 4, 2.5% |
A clinical case characterized by: (1) generalized or localized skin rash, either maculopapular or vesiculopustular; (2) umbilicated skin lesions; (3) lymphadenopathy | ||
Confirmed MPX case | FALSE | 23, 14.1% |
Probable MPX case | TRUE | 69, 42.3% |
Doubtful MPX case | FALSE | 60, 36.8% |
Don’t know | - | 11, 6.7% |
The case-fatality ratio of smallpox usually ranged between… | ||
… 4% and 11% | FALSE | 47, 28.8 |
… 14% and 19% | FALSE | 22, 13.5% |
… 20% and 30% | FALSE | 32, 19.6% |
… 30% and 40% | TRUE | 29, 17.8% |
Don’t know | - | 33, 20.2% |
MPX is able to survive for several days on contaminated surfaces | TRUE | 69, 42.3% |
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Variable | No./163 | Average ± SD |
---|---|---|
Gender | ||
Male | 57, 35.0% | |
Female | 106, 65.0% | |
Age (years) | 42.9 ± 10.0 | |
Age ≥ 50 years | 35, 21.5% | |
Seniority (years) | 16.3 ± 10.3 | |
Seniority ≥ 20 years | 51, 31.3% | |
Working as … | ||
Occupational Physician | 49, 30.1% | |
General Practitioner | 73, 44.8% | |
Public Health Professional | 41, 25.2% | |
Living in … | ||
Northern Italy 1 | 90, 55.2% | |
Central Italy 2 | 41, 25.2% | |
Southern Italy/Islands 3 | 28, 17.2% | |
Other EU country | 4, 2.4% | |
Previously vaccinated against smallpox | 35, 21.5% | |
Previous knowledge of MPX | 44, 27.0% | |
Any University-level formation on smallpox | 69, 42.3% | |
Acknowledging MPX infection in Europe as … | ||
… frequent/very frequent | 6, 3.7% | |
… severe/very severe | 35, 21.5% | |
Perceiving MPX as a likely occurrence during daily activity (agree/totally agree) | 49, 30.1% | |
Perceiving MPX as potentially affecting daily working activities (agree/totally agree) | 53, 32.5% | |
Confident to be able to recognize a MPX case (agree/totally agree) | 27, 16.6% | |
General Knowledge Score (%) | 51.8 ± 13.0 | |
General Knowledge Score > median (50.0%) | 81, 49.7% | |
Risk Perception Score | 22.3 ± 14.6 | |
Risk Perception Score > median (20.0%) | 80, 49.1% | |
Favorable/Highly favorable to using smallpox vaccination against MPX | 96, 58.9% | |
Favorable/Highly favorable to receive smallpox vaccination against MPX | 105, 64.4% | |
Vaccinated against SARS-CoV-2 during 2022 | 163, 100% | |
Vaccinated against Seasonal Influenza during 2021 | 137, 84.0% | |
Acknowledging as significant/very significant aspects for candidate MPX vaccines … | ||
… avoiding natural infection | 147, 90.2% | |
… avoiding complications | 148, 90.8% | |
Willingness to pay for vaccine | ||
Not interested | 52, 31.9% | |
<10€ per shot | 39, 23.9% | |
10–49€ per shot | 33, 20.2% | |
50–99€ per shot | 21, 12.9% | |
≥100€ per shot | 18, 11.0% | |
Optimal price for vaccine | ||
It should be offered at no cost | 107, 65.6% | |
<10€ per shot | 26, 16.0% | |
10–49€ per shot | 24, 14.7% | |
50–99€ per shot | 4, 2.5% | |
≥100€ per shot | 2, 1.2% |
Variable | Attitude towards VARV Vaccination | p-Value | ||
---|---|---|---|---|
Somewhat Agree (No./93, %) | Somewhat Disagree (No./63, %) | adjOR (95%CI) | ||
Male Gender | 35, 36.5% | 22, 32.8% | 0.756 | - |
Age > 50 years | 14, 14.6% | 21, 31.3% | 0.018 | 2.224 (0.252; 19.645) |
Seniority > 20 years | 23, 24.0% | 28, 41.8% | 0.025 | 0.723 (0.176; 2.978) |
Working as … | 0.322 | - | ||
Occupational Physician | 32, 33.3% | 17, 25.4% | ||
General Practitioner | 43, 44.8% | 30, 44.8% | ||
Public Health Professional | 21, 21.9% | 20, 29.9% | ||
Living in … | 0.401 | - | ||
Northern Italy 1 | 55, 57.3% | 32, 52.2% | ||
Central Italy 2 | 21, 21.9% | 20, 29.9% | ||
Southern Italy/Islands 3 | 16, 16.7% | 12, 17.9% | ||
Other EU country | 4, 4.2% | 0, - | ||
Previously vaccinated against smallpox | 13, 13.5% | 22, 32.8% | 0.006 | 0.213 (0.037; 1.223) |
Previous knowledge of MPX | 24, 25.0% | 20, 29.9% | 0.612 | - |
Any University-level formation on smallpox | 42, 43.8% | 27, 40.3% | 0.781 | - |
Acknowledging MPX infection in Europe as … | ||||
… frequent/very frequent | 3, 3.1% | 3, 4.5% | 0.977 | - |
… severe/very severe | 22, 22.9% | 13, 19.4% | 0.731 | - |
Perceiving MPX as a likely occurrence during daily activity (agree/totally agree) | 31, 32.3% | 18, 26.9% | 0.569 | |
Perceiving MPX as potentially affecting daily working activities (agree/totally agree) | 30, 31.3% | 23, 34.3% | 0.808 | - |
Confident to be able to recognize a MPX case (agree/totally agree) | 18, 18.8% | 9, 13.4% | 0.494 | - |
Knowledge Score, > median (50.0%) | 45, 46.9% | 36, 53.7% | 0.483 | - |
Risk Perception Score, > median (20.0%) | 55, 57.3% | 25, 37.3% | 0.019 | 0.846 (0.348; 2.059) |
Favorable/Highly favorable to receive smallpox vaccination against MPX | 86, 89.6% | 19, 28.4% | < 0.001 | 21.416 (7.290; 62.914) |
Vaccinated against Seasonal Influenza during 2021 | 90, 93.8% | 47, 70.1% | < 0.001 | 6.443 (1.798; 23.093) |
Willingness to pay for vaccine | ||||
Not interested to pay | 18, 18.8% | 34, 50.7% | < 0.001 | 1.047 (0.348; 3.154) |
It should be offered at no cost | 59, 61.5% | 48, 71.6% | 0.238 | - |
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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. https://doi.org/10.3390/tropicalmed7070135
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. Tropical Medicine and Infectious Disease. 2022; 7(7):135. https://doi.org/10.3390/tropicalmed7070135
Chicago/Turabian StyleRiccò, Matteo, Pietro Ferraro, Vincenzo Camisa, Elia Satta, Alessandro Zaniboni, Silvia Ranzieri, Antonio Baldassarre, Salvatore Zaffina, and Federico Marchesi. 2022. "When a Neglected Tropical Disease Goes Global: Knowledge, Attitudes and Practices of Italian Physicians towards Monkeypox, Preliminary Results" Tropical Medicine and Infectious Disease 7, no. 7: 135. https://doi.org/10.3390/tropicalmed7070135