Survey: International healthcare worker experiences and perceptions of the MPOX outbreak in multiple countries in 2022. Image credit: Corona Borealis Studio / Shutterstock
*Important Notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and should not be considered definitive, treated as a guide for clinical practice/health-related actions, or treated as established information.
Recently, a survey was conducted to capture the experiences and perceptions of multinational healthcare workers during the MPOX epidemic around the world.
The study is now publicly available on the medRxiv preprint* server.
background
Healthcare workers play a critical role in the preparedness and resilience of health systems during public health emergencies. COVID-19 has taught the world how severely a pandemic can impact the health and well-being of health care workers.
During a pandemic like COVID-19, frontline healthcare workers face enormous challenges in providing essential services to a population with a disease whose clinical course and prognostic factors are largely unknown. They also have to deal with uncertainty, anxiety, stress, fear of infection, shortages of personal protective equipment, and long working hours.
Real-world studies have reported a wide range of experiences of adversity, psychological distress, and resilience experienced by health workers during the COVID-19 pandemic. International knowledge exchange and transfer programs have been found to partially mitigate the difficulties experienced by health workers during the pandemic.
The worldwide outbreak of monkeypox (MPOX) infections in 2022–2023 has had a significant impact on healthcare workers, especially those residing in non-endemic countries such as Europe and the United States. The occurrence of MPOX outside historically affected areas has brought new challenges, especially in the context of ongoing global health crises such as COVID-19. Most of the challenges faced by healthcare workers are related to their lack of knowledge and experience regarding the disease.
In this study, an international team of scientists explored the personal and clinical experiences of multinational healthcare workers during the MPOX outbreak.
Study design
The survey was conducted among healthcare workers involved in the clinical management of the MPOX epidemic from August to October 2022. A total of 725 multinational healthcare workers from 41 non-endemic countries participated in the survey.
Self-reported data on clinical workload, safety, preparedness, workplace training and support, mental health, and vaccination were collected via an online questionnaire.The outbreak of MPOX outside of historically affected areas has posed new challenges, especially in the context of an ongoing global health crisis such as COVID-19.
Important Observations
The survey involved healthcare workers from the UK, European Union, Caribbean, Central and South America, the US and Canada.
Approximately 91% of participants were physicians specializing in sexual health or infectious diseases, and 34% were involved in MPOX policy.
About 41% of respondents reported that their working hours had increased during the MPOX outbreak, and 87% reported dealing with this additional load on top of their regular clinical responsibilities. This additional workload, without any elimination of existing responsibilities, exacerbated pressures on a healthcare system already strained by the ongoing pandemic.
Approximately 30% of participants reported knowing nothing about MPOX before the outbreak, and only 1% reported having experience treating MPOX cases before the outbreak, highlighting a large knowledge gap among healthcare providers regarding re-emerging infectious diseases and a major concern given the increasing frequency of outbreaks.
More than 25% of participants reported initially misdiagnosing patients with MPOX-associated rash as having another illness, with the most commonly reported misdiagnoses being chickenpox, syphilis, and herpes.
More than half of those surveyed agreed that their institution provided them with clear, timely and reliable information about the disease and that they received the necessary education, training and guidance. However, there were notable regional differences, with health workers in the Caribbean, Central and South America reporting significantly less support from their institutions than those in Europe and North America.
Approximately 60% and 72% of participants reported following local service guidelines and national guidelines, respectively. Approximately 40% of participants expressed dissatisfaction with the support they received from national public health agencies. This dissatisfaction was particularly pronounced in areas that have historically had limited access to public health resources, highlighting the need for more equitable support structures.
More than half of the study participants reported feeling moral distress as a result of their work experience managing suspected or confirmed clinical cases of MPOX, and approximately 37% of participants reported that their psychological health was impaired by moral distress.
The findings highlight the high mental strain suffered by healthcare workers, which may have long-term implications for the sustainability of the workforce.
Vaccination to prevent mpox
Fewer than 50% of participants reported receiving smallpox vaccination before the smallpox outbreak. Approximately 1 in 3 people in the United States, Europe, and Canada had been vaccinated, but vaccination rates were as low as 1 in 10 in the Caribbean, Central America, and South America.
Overall, vaccination rates were high across all regions surveyed, with over 90% of participants in each region indicating that people at high risk for MPOX infection should be offered vaccination before exposure.
Despite this high acceptability, the survey found significant inequalities in access to the vaccine, particularly in low-resource areas, reflecting the challenges faced during the COVID-19 pandemic.
Significance of the study
This multinational survey revealed a significant gap in knowledge about MPOX among health professionals, despite the fact that this neglected disease has been prevalent in humans since 1970.
These knowledge gaps highlight the urgent need to strengthen global pandemic response efforts for frontline health workers.
The findings suggest that health systems should prioritize education and training of health workers on emerging infectious diseases to ensure rapid and effective responses during future outbreaks.
Surveys found high vaccine acceptance and uptake among health care workers involved in managing suspected and confirmed MPOX cases. However, vaccine inequities and access were prominent in the Caribbean, Central America, and South America. This inequity hinders the effectiveness of outbreak responses in these regions and raises concerns about the overall equity and efficiency of global health interventions.
These inequities highlight the need to prioritize MPOX vaccination for healthcare workers, especially in areas with scarce infection prevention resources. The study calls for a coordinated global effort to address these disparities and ensure that healthcare workers, especially those in resource-poor settings, are adequately protected. The scientists say similar surveys should be conducted among clinicians in Africa to understand how the lack of availability or access to essential resources such as vaccines affects their mental health and perceptions of support.
Overall, the findings highlight the crucial importance of strengthening the resilience of global health systems and multisectoral approaches to prepare for future epidemics. Building this resilience must include addressing the systemic issues that lead to health worker burnout and mental distress, and ensuring the global health workforce is prepared and supported for future public health emergencies.
*Important Notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and should not be considered definitive, treated as a guide for clinical practice/health-related actions, or treated as established information.
