Mpox knowledge, Attitudes towards Mpox vaccine and Hesitancy for Mpox vacciantion among Teachers in Kenya

Mpox knowledge, Attitudes towards Mpox vaccine and Hesitancy for Mpox vacciantion among Teachers in Kenya | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mpox knowledge, Attitudes towards Mpox vaccine and Hesitancy for Mpox vacciantion among Teachers in Kenya Patrick Mutua, Michael Gicheru, Joshua Mutiso, Erick Seremu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5511275/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Sixteen African countries, including Kenya, reported mpox cases in July and August, prompting the Africa Centers for Disease Control to declare the outbreak a Public Health Emergency of Continental Security on 13 th August 2024. The World Health Organization issued an advisory for mpox-related prevention in schools whereby teachers are expected to support mpox-infected students. There is a dearth of information of mpox knowledge and attitudes toward mpox vaccination among teachers in Kenya. Method : An online survey involving 1139 teachers was conducted from 21 st August to 3 rd October, 2024 to determine the level of mpox knowledge and attitudes toward mpox vaccine and hesitancy factors. Results : The teachers’ mean mpox knowledge score was 8.2 out of 12 whereas the mean mpox attitude score was 3.7 out of 6. At the time of the survey, more than 34 % of the respondents were not aware of mpox cases in the country. The hesitancy rate for vaccination was 49.78 %. More than 62 % of participants cited concerns about vaccine side effects as the main reason for hesitancy. However, participants with certificate and diploma were more likely to accept to be vaccinated against mpox. Only 1.23 % of the participants received mpox information from the Teachers Service Commission. Conclusions : This study identifies gaps in mpox knowledge and attitudes toward mpox vaccination. It suggests that collaboration between the Teachers Service Commission and healthcare providers can ensure effective school community-based prevention strategies by improving mpox knowledge and attitudes toward mpox vaccination among teachers in Kenya. Attitude Mpox Knowledge Mpox Vaccination Hesitancy Teachers Figures Figure 1 Figure 2 Introduction Mpox disease, formerly known as Monkeypox, is a zoonotic disease caused by the mpox virus which belongs to the genus Orthopoxvirus and the family Poxviridae (Kugelman et al. 2014; Yang et al. 2023). The virus was first isolated in monkeys in 1958 but the first human case was reported in the Congo in 1970 (Cabanillas et al. 2023). Central Africa, particularly the Congo, remains the epicenter of infection (Kelly et al. 2023). In 2022, the World Health Organization (WHO) declared the mpox outbreak a Public Health Emergency of International Concern (PHEIC) after 110 countries were affected (WHO. 2023). The WHO lifted the PHEIC in 2023 after cases of mpox infections declined substantially, especially in the Global North . (WHO. 2023). However, the WHO lifted the PHEIC despite increasing cases of mpox outbreaks in Africa. In 2022, for example, the Africa Centers for Disease Control (Africa CDC) and Prevention reported an estimated 8,000 mpox cases, which increased by approximately 78.5 % to 15,000 cases in 2023 and 18,000 cases in August 2024 (Africa CDC. 2024). On 13 th August 2024, the Africa CDC and Prevention issued a Public Health Emergency of Continental Concern in response to rapid the spread of mpox cases reported across 16 African countries (Africa CDC. 2024). Kenya reported the first mpox case on 31 st July 2024, and, as of October 2024, 12 mpox cases had been confirmed in the country (UNICEF. 2024). Mpox transmission is a rapidly evolving aspect of this disease. While the natural hosts of the mpox virus are rodents and monkeys and account for zoonotic transmission, recent studies have shown increased human-to-human mpox transmission mainly through sexual intercourse, especially among men who have sex with men and through human-to-human contact, whose cases have increased due to rapid population movements and globalization (Del and Malani. 2022). Mpox transmission has also been reported to take place vertically from infected pregnant women to newborns (Del and Malani. 2022). Additionally, transmission also occurs by inhaling respiratory droplets from infected patients (Beeson et al. 2023). Currently, there is no known cure for mpox, and vaccination remains the most viable strategy for preventing widespread outbreaks of the disease (Berry et al. 2024). The mpox virus shares surface antigens with the smallpox virus. On this basis, the smallpox vaccine is reported to confer cross-antigenic protection of between 35% and 85 % against mpox (Christodoulidou and Mabbot. 2023; Fahima et al. 2023). The withdrawal of the smallpox vaccine in 1981 implies that few people have been vaccinated. Moreover, the smallpox vaccine confers immunity against Orthopoxviruses for only 3 – 5 years (Jon. 2001). The Africa CDC and Prevention is currently collaborating with the European Commissions’ Health Emergency and Bavarian Nordic to secure over 215, 0000 doses of the MVA-BN vaccine to vaccinate against mpox on the continent (European Commission. 2024). However, the increasing number of mpox outbreaks on the continent may render the requested dosses inadequate, and an advisory to adopt the WHO guidelines of distributing vaccines in the context of limited supply, as was the case with COVID-19 vaccines, may be sought (WHO. 2023). While studies on mpox knowledge and attitudes toward mpox vaccination have reported a substantial reduction in the spread of infection and in the alleviation of vaccine hesitancy through improved public knowledge of mpox and attitudes towards the mpox vaccine, such studies have been conducted primarily in nonendemic regions and are limited in Africa (Jahromi et al. 2024; David et al. 2024). Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination services, is listed among the ten global health threats by the WHO (WHO. 2015) and is the main reason for the clustering of endemics such as mpox and Ebola in central Africa (Mercy et al. 2024). In 2022, the Congo and Nigeria were the African nations most affected by the mpox outbreak (WHO. 2022). A survey of non-health and health professionals in the Congo reported mpox vaccination acceptance rate of 61 % (Petrichko et al. 2024). In Nigeria, a study reported mpox knowledge score of 60.5 % among healthcare providers, however, the attitude score towards mpox vaccination was 28.9 % (Awoyomi et al. 2023). In Egypt, a report showed that half of healthcare providers sampled had adequate mpox knowledge, but the perception of mpox vaccination was moderate (Amer et al. 2024). Current research on mpox knowledge and attitudes toward vaccination among non-health care providers in Africa is scarce. A systematic review on the assessment of mpox knowledge and attitudes toward mpox vaccination in the world’s population reported that 54 % of the subjects studied had poor mpox knowledge whereas 35 % were not willing to receive mpox vaccine (Tanashat et al. 2024). Research has demonstrated that HIV patients, pregnant women, patients on immunosuppressive drugs and children aged 15 years and younger are the most susceptible populations (Lu et al. 2023). An assessment of the risks posed by mpox outbreaks among children prompted the WHO Africa Region office to issue an interim report on public health advice for mpox-related prevention and control measures in school settings (WHO Africa Region Office. 2024). In the report, teachers are expected to identify, isolate and support students with symptoms related to mpox by referring them to healthcare providers for medical attention (WHO Africa Region Office. 2024). According to the Teachers Service Commission (TSC) of Kenya, the government agency that employs teachers in the country, the basic education school community comprises 222, 000 teachers working in 32,594 primary schools and 128,000 instructors who teach in 10,482 secondary schools (TSC. 2023). Additionally, the school communities have an estimated 10.4 million learners aged between 6-13 years and 3.9 million learners aged between 13 -18 years attending primary schools and secondary institutions, respectively (TSC. 2023). The basic education learning ecosystem in Kenya is vulnerable to the mpox outbreak, not only because the students are within the vulnerable age group, but also because many schools are congested, and have an inadequate supply of water and insufficient sanitation infrastructure. Furthermore, most institutions are far from medical facilities (Nation Media. 2024; UNESCO. 2020). Additionally, an estimated 70 % of students commute to school from their homes, increasing likelihood of transmitting mpox disease from communities to institutions (UNESCO. 2020). To effectively curb mpox cases in school settings, baseline data on teachers’ knowledge of mpox and attitudes toward mpox vaccination in Kenya are needed. The gaps identified can be addressed through public education awareness of mpox disease and by improving teachers’ attitudes toward mpox vaccination before the implementation of mpox vaccination programs targeting school communities in the Republic of Kenya. MATERIAL AND METHODS Study setting, design and ethical considerations This is a cross‑sectional study to examine knowledge of mpox and attitudes toward mpox vaccination as well as identify factors associated with mpox vaccine hesitancy among teachers in Kenya. The study was conducted from 21 st August to 3 rd October 2024 and in accordance with the Helsinki declarations of 1975 as revised in 2013. The TSC Sub County directors, who are in charge of teacher management in the 300 sub counties in Kenya, were first taken through the study design and objectives by the authors. The study objectives were then explained to the participants via virtual meetings that were conducted by the TSC Sub Cunty Directors at the beginning of the study period. The participants were required to read and agree to provide informed consent before completing the online questionnaire. Participants who did not agree to provide informed consent were not allowed to proceed with the study. The potential risks and benefits of the study were well explained. The respondent’s confidentiality was assured by the collection of data that were completely anonymous and that no personal identifiable information was collected. The respondents were required to consent to voluntary participation and were free to choose to not participate or end their participation at any time of the study. The participants were free to contact the study authors if they had any questions or comments. Inclusion and exclusion criteria The study sampled and included registered teachers employed by the TSC and working in primary and secondary schools in Kenya. Registered but unemployed teachers were not included in the study. Furthermore, only teachers who read and agreed to provide informed consent and submitted their responses to the online questionnaire on time were included in the final study sample. Sample size There are 350, 000 teachers employed by the TSC in more than 32,000 schools in Kenya (TSC. 2023). The sample size was determined using the online Raosoft sample size calculator (Raosoft. 2004). For a population of 350,000 teachers with a 95% confidence interval and a 5 % margin error, the minimum number of the estimated sample was 384. As this is the first cross-sectional study of mpox knowledge and perceptions of the mpox vaccine and hesitancy factors involving teachers in Kenya, the sample size was increased by about 4-fold to ensure that a representative sample obtained an estimated maximum sample size of approximately 1,500. To ensure an inclusive sample of teachers from all parts of the country, respondents were required to indicate their schools’ sub-county in the questionnaire for a random proportional distribution of the submitted questionnaires on the basis of the number of teachers in each of the 300 sub-counties. Data collection and analysis A questionnaire that was used in a previous study by Yang et al. (2024) was slightly modified to reflect respondents’ sub counties and their awareness of mpox cases reported in Kenya at the time of the interview. The questionnaire was validated through a test-retest reliability method involving 185 randomly sampled teachers in Makueni County, Kenya. The questionnaire had four sections: The first section sought information on socio-demographic characteristics of the respondents, awareness of mpox cases reported in Kenya, and sources of mpox information. The second section contained 12 questions for assessing respondents’ mpox knowledge whereas the third section included 6 questions for determining respondents’ attitudes toward mpox vaccine. The fourth section had included a list of 10 hesitancy factors for participants to select from. Online questionnaires in Google forms were shared with TSC Sub County Directors for distribution to randomly selected teachers in Kenya. The questionnaires were coded, and the data collected were entered into an Excel file, which was imported into IBM SPSS Statistics 27 software for statistical analysis. A value of P ≤ 0.05 was considered significant. Categorical data are presented as frequencies and percentages. Continuous data were checked for normality and then presented as the means and standard deviations (SD) for normally distributed variables. Results (A) Demographic characteristics of the respondents A total of 1,549 participants submitted their responses; however, 410 questionnaires were excluded because they were incomplete, and, therefore, 1,139 questionnaires constituted the final sample representing a response rate of 75.9 % of the estimated sample size. The respondents included 672 males and 467 females accounting for 59 % and 41 % of the respondents, respectively. The median age group of the respondents was 35 - 44 years. More than 40 % of the sampled teachers had a certificate or diploma, 41 % had a degree certificate while 18.8 % had postgraduate qualifications. Primary and secondary school teachers comprised 59.35 % and 40.65 % of the respondents, respectively. More than 71 % of the participants were from day schools. Table 1 shows summary of the respondents’ demographic characteristics Table 1 : Demographic characteristics of the respondents Characteristic Category Frequency (N=1139) Percentage Sex Female 467 41.00 Male 672 59.00 Marital status Married 980 86.04 Unmarried 159 13.96 Education level Certificate/Diploma 456 40.04 Graduate 469 41.18 Postgraduate 214 18.79 Age 18-24 11 0.97 25-34 362 31.78 35-44 325 28.53 45 and above 441 38.72 Type of school Primary 676 59.35 Secondary 463 40.65 School category Day 813 71.38 Boarding 150 13.17 Day/Boarding 176 15.45 Subjects All 499 43.81 Arts 204 17.91 Linguistics 140 12.29 Science/Math/Technical 296 25.99 Experience 0-4 years 210 18.44 5-9 years 272 23.88 10-14 years 174 15.28 15-19 years 109 9.57 20 and above 374 32.84 (B) Sources of mpox information As shown in Figure 1, more than 73 % of the participants acquired mpox information from digital portals and social media such as WhatsApp and Facebook. More than one-fifth of the respondents obtained mpox information from traditional media including television, newspapers and radio. Approximately 2.19 % and 2.6 % of the participants obtained mpox information from communications with colleagues and friends and from other sources, respectively. Only 1.23 % of the sampled teachers obtained mpox information from employers (Figure 1). At the time of the interviews, more than 34 % (388/1139) of the respondents were not aware of the mpox cases reported in the country. (C) Respondents’ knowledge of mpox disease A total of 12 questions were used to assess respondents’ knowledge of mpox disease. The mpox knowledge score was calculated as the proportion of correct responses and the quotient multiplied by 12. The mean mpox knowledge score was 8.2 ( SD =1.6), translating to mpox knowledge percentage score of 68.3 % (8.2/12). The median score was 8.6 and, therefore, an adequate mpox knowledge score was considered for values between 8.6 to 12. An estimated 86 % and 72 % of the respondents correctly answered that mpox was an infectious disease and was caused by a virus. More than 71 % of the participants correctly responded that people are susceptible to mpox. However, more than 52 % of the respondents incorrectly reported that mpox has a cure. The responses concerning mpox symptoms revealed that 29 % and 25 % of the participants were not aware that mpox can cause fatigue and fever, respectively. Additionally, 37 % and 27 % of the respondents incorrectly indicated that mpox does not cause swollen lymph nodes and headache, respectively. An estimated 39 % of the sampled teachers were not aware that mpox causes back or muscle aches. Table 2 shows summary of the responses obtained in each of the 12 questions Table 2 . Assessment of respondents’ knowledge of mpox S/No Question Knowledge Score N=1139 Correct response (%) Incorrect response (%) 1 Mpox is infectious 10.4 987 (86.65) 152 (13.35) 2 Mpox is caused by a virus 8.6 821 (72.08) 318 (27.92) 3 People are susceptible to Mpox 8.5 809 (71.03) 330 (28.97) 4 There is no treatment for Mpox 5.8 546 (47.94) 593 (52.06) 5 There is a safe Mpox vaccine 5.0 478 (41.97) 661 (58.03) 6 Mpox can cause fever 9 853 (74.89) 286 (25.11) 7 Mpox can cause headache 8.7 829 (72.78) 310 (27.22) 8 Mpox can cause fatigue 8.5 807 (70.85) 332 (29.15) 9 Mpox cause swollen lymph nodes 7.8 737 (64.71) 402 (35.29) 10 Mpox can cause skin rash 10 952 (83.58) 187 (16.42) 11 Mpox cause back/muscle aches 7.3 692 (60.76) 447 (39.24) 12 Routes of transmission of Mpox 9.2 869 (76.30) 270 (23.71) (D) Respondents’ attitudes toward the mpox vaccine Six questions were used to determine respondents’ attitudes toward the mpox vaccine. An attitude score was derived by calculating the number of appropriate responses to the 6 questions and a mean attitude score of 3.7 (SD=0.72), translated to an average attitude percentage score of 62 % (3.7/6), was obtained. The median attitude score was 3.4. An adequate attitude score was considered for values between 3.4 and 6, whereas poor attitude scores ranged from 0 to 3.3. More than 81 % of the participants indicated that it is important to be vaccinated against mpox. However, when asked “would you be willing to get vaccinated against mpox”, the percentage dropped to 50.22 % of the participants who would agree to be vaccinated. The respondents had inadequate attitude scores of 3.3 and 3.0 in terms of vaccine safety and in willing to get vaccinated, respectively. Additionally, an inadequate attitude score of 3.2 for the willingness of participants to be vaccinated if the mpox vaccine was provided for free was reported (3.2). Table 3 presents a summary of the mpox attitude scores. Table 3. Assessment of participants’ perceptions of the mpox vaccine S/No Question Attitude Score N=1139 Correct Response (%) Incorrect Response (%) 1 Do you think it is important to get vaccinated against Mpox 4.9 932 (81.83) 207 (18.17) 2 Mpox vaccine is safe 3.3 635 (55.75) 504 (44.25) 3 Mpox vaccine is effective 3.4 646 (56.72) 493 (43.28) 4 Mpox vaccination of teachers is important 4.1 785 (68.92) 354 (31.08) 5 Would you like to be vaccinated 3.0 572 (50.22) 567 (49.78) 6 Would you like to be vaccinated against Mpox if the vaccine is free 3.2 615 (53.99) 524 (46.01) (E) Association between groups and their level of mpox knowledge and attitudes toward mpox vaccination A chi-square test was applied to determine the statistical associations between background characteristics (age, gender, marital status, level of education and type of school a teacher taught) and their level of mpox knowledge as well as their attitudes toward mpox vaccination. There was no significant ( P ˃ 0.05) association between any of the respondents’ background characteristics and their level of mpox knowledge or their attitudes toward mpox vaccination. In order to evaluate the correlation between mpox knowledge and attitude towards mpox vaccination, a Phi test was conducted and a value of 0.077 ( P =0.05) was obtained. (F) Demographic characteristics of participants and their willingness to receive mpox vaccine The acceptance group represented more than 50 % (572/1139) of the respondents whereas 49.78 % of the participants (567/1139) composed the hesitant group. A chi-square test was used to determine the differences in the distribution of vaccination hesitancy among characteristics which included age, gender, level of education, marital status, type of school, category of school and experience. The results revealed that only the level of education was significantly different ( P = 0.03) between mpox vaccine acceptance and hesitancy. The rates for vaccine acceptance and vaccine hesitancy for certificate/diploma participants were 54.8 % and 45.17 %, respectively. For undergraduates, the acceptance and hesitation rates were 46.48 % and 53.51 %, respectively. The postgraduate vaccine acceptance and hesitant rates were 48.6 % and 51.4 % respectively (Table 4). A logistic regression analysis affecting mpox vaccine acceptance, (1= vaccine acceptance, 0= vaccine hesitancy), indicated that certificate/diploma respondents were 1.534 times more likely to be willing to be vaccinated against mpox (OR=1.534, 95 % CI: 0.165-6.688, P < 0.01). Table 4 presents a summary of the participants’ background characteristics and mpox vaccine acceptance and hesitation rates Table 4. A chi square test of the significance of the background characteristics of participants on their mpox vaccine acceptance/hesitance Characteristic Category Willingness to be Mpox vaccinated (%) Hesitancy against Mpox vaccination (%) P values Age 18-24 8 (72.7) 3 (27.3) 0.2 25-34 187 (51.7) 175 (48.3) 35-44 151 (46.5) 174 (53.5) 45 and above 227 (51.5) 214 (48.5) Gender Female 229 (49.0) 238 (51) 0.50 Male 343 (51.0) 329 (49.0) Education Cert/Diploma 250 (54.8) 206 (45.2) 0.03 Undergraduate 218 (46.5) 251 (53.5) Postgraduate 104 (48.4) 110 (51.6) Marital Status Married 488 (49.8) 492 (50.2) 0.48 Unmarried 84 (52.8) 75 (47.2) Type of school Primary 352 (52.1) 324 (47.9) 0.13 Secondary 220 (47.5) 243 (52.5) Category of school Day 418 (51.4) 395 (48.6) 0.25 Day/Boarding 88 (50) 88 (50) Boarding 66 (44) 84 (56) Experience (Years) 0-4 101 (48.1) 109 (51.9) 0.91 5-9 136 (50) 136 (50) 10-14 84 (48.3) 90 (51.7) 15-19 50 (45.9) 59 (54,1) ≥20 189 (50.5) 185 (49.5) (G) Mpox hesitancy factors among the participants On the basis of the WHO 3Cs (convenience, confidence, complacency) vaccine hesitancy model (WHO. 2015), participants were provided with a list of 10 hesitancy factors to choose from. As shown in Figure 2, more than 62 % of the respondents hesitate from receiving the mpox vaccine because of they are worried about the side effects of the vaccine. More than 18 % and 16 % of the participants would hesitate mpox vaccination because of a failure to receive professional advice and because they were concerned about vaccine effectiveness, respectively. Approximately, 2.9 % of the participants would hesitate to be vaccinated because they had been vaccinated against smallpox whereas more than 1.4 % of the participants would hesitate to receive mpox vaccination because they believed that mpox was not a serious infection. Figure 2 shows a summary of the reasons for hesitancy toward the mpox vaccine among the respondents. Discussion On 13 th August 2024, the Africa CDC and Prevention declared mpox a Public Health Emergency of Continental Concern. The reason for the declaration was to call for a unified, continent-wide responses to the rapidly spreading disease and for individual governments to put measures in place to stop any further outbreak of the infection (European Commission. 2024). In September 2024, the WHO released a report to provide guidance on measures to reduce possible mpox outbreaks in schools. The report recommends that teachers identify, isolate and refer learners showing mpox related symptoms to medical facilities (WHO Africa Region Office. 2024). At the beginning of the survey, which was a month after the first mpox case had been reported in Kenya, 34 % of the participants were not aware of mpox cases reported in the country. With respect to the sources of mpox information, more than 73 % of the participants obtained mpox information from digital portals such as WhatsApp and Facebook. While the accuracy of the mpox information disseminated via digital portals to the respondents was not confirmed by the current study, it is important to note that mpox disinformation and misinformation have been reported to be spread through digital portals (Diaz. 2023). Disease disinformation and misinformation have been associated with vaccine hesitancy (Baldwin et al. 2023). Most employees trust information about diseases if the source of the information is from the employer or from collaborations of the employer with healthcare providers (Lazarus et al. 2021). In this study, only 1.23 % of the participants had received mpox information from the TSC. Therefore, there is need for the TSC to collaborate with healthcare providers to improve the dissemination of mpox information to teachers. In Kenya, government agencies have traditional media including television, newspapers and radio to transmit COVID-19 information. A global survey on the use of traditional media reported reduced COVID-19 vaccination hesitancy in situations where governments and other public health providers effectively used television, newspapers and radio for the dissemination of COVID-19 disease information (Piltch-Loeb et al. 2021). In this survey, more than 20 % of the respondents had received mpox information through traditional media. Improving population knowledge of mpox disease through public education is critical for ensuring a high acceptance rate of the mpox vaccine (Cataldi et al. 2020). In Africa, studies on mpox knowledge and attitudes toward mpox vaccine among non-health professionals are few. Furthermore, studies have reported inadequate mpox knowledge and attitude towards mpox vaccines on the continent (Nicaisei et al. 2024). In a study involving health and non-health professionals in the Congo, a mpox vaccine acceptance rate of 61 % was reported, however, more than 17 % of the respondents had no knowledge related to mpox (Petrichko et al. 2024). In Algeria, a study involving health and life sciences students at universities found a moderate mpox vaccination acceptance level of 48.5 % and a low level of mpox knowledge of 42.8 % (Lounis et al. 2024). In Nigeria, only 28.9 % of participants in a study involving 1,452 respondents had adequate mpox knowledge and positive perceptions of the mpox vaccine (Awoyomi et al. 2023). We report, for the first time in Kenya, the findings of this study involving 1,139 sampled teachers who recorded mpox knowledge and attitude scores toward mpox vaccination of 68.3% and 62 %, respectively. Significant mpox knowledge gaps were identified in areas related to mpox treatment, the availability of a safe mpox vaccine and mpox symptoms. While more than 86 % and 72 % of the respondents knew that mpox is an infectious disease caused by a virus, respectively, only 47.94 % knew that there is no cure for mpox. More than 58 % of the participants were not aware of the existence of a safe mpox vaccine. These knowledge gaps are likely to impede the successful roll out of mpox vaccination among teachers and which can be a barrier in positioning teachers for the dissemination of mpox information and mpox vaccination in school communities in Kenya. The initial prodromal symptoms of mpox include swollen lymph nodes, fever, skin rash, and muscle aches (WHO. 2024). The respondents had inadequate knowledge of mpox symptoms. For example, more than 35 % of the participants, were not aware that mpox can cause swollen lymph nodes. Additionally, more than 39 % and 16 % of the participants lacked knowledge related to muscle aching and skin rash as mpox symptoms, respectively. These knowledge gaps in mpox symptoms may render teachers unable to identify, isolate and support mpox affected learners as stipulated in the WHO interim report on student support by teachers in the context of the mpox outbreak in school settings (WHO Africa Region Office. 2024). The respondents had inadequate attitudes toward the mpox vaccine. Only 55.75 % and 56.72 % of the participants believed that the mpox vaccine was safe and effective, respectively. Whereas an estimated 81 % of the respondents agreed it is important to be vaccinated against mpox, this dropped to just over 50 % of the participants when they were asked if they would personally agree to be vaccinated. The negative attitude toward mpox vaccination may be a barrier to the successful roll out of mpox vaccination programs targeting teachers in Kenya and, therefore, the need to launch comprehensive education strategies targeting changes in teachers’ attitudes toward the mpox vaccine. This study revealed a weak association between mpox knowledge and attitudes toward the mpox vaccine. Therefore, multifaceted educational and vaccination campaign programs should aim at improving the association between teachers’ mpox knowledge and their attitudes toward mpox vaccination. We found a significant association between respondents’ level of education and the mpox vaccine acceptance rate, especially among the certificate and diploma respondents. More than 40 % of the participants had a certificate/diploma as the highest level of qualification. Additionally, 430 participants, representing more than 94 % of the certificate/diploma respondents, were sampled from primary schools. In Kenya, more than 62 % of teachers work in primary institutions (TSC. 2023). Furthermore, there are more than 10 million learners in primary schools and many of the institutions are congested, lack sufficient sanitation facilities and are mostly day schools with more than 71 % of the learners commuting to their schools (UNESCO. 2020). These factors predispose primary school communities to mpox disease outbreaks. The government and healthcare providers should, therefore, leverage the high mpox vaccine acceptance rate among certificate/diploma primary school teachers and seek to further improve their mpox knowledge and attitudes toward the mpox vaccine. This will help ensure the successful initiation of mpox vaccination campaigns targeting teachers in Kenya. With reference to the WHO 3Cs (Convenience, Complacency, and Confidence) vaccine hesitancy model (WHO. 2015), more than 62 % and 18 % of the participants would hesitate to receive the mpox vaccination because they were worried about the side effects of the vaccine and not getting professional advice about the vaccine, respectively. Additionally, more than 3% and 2.9 % would hesitate to receive mpox vaccination because mpox will not be endemic in Kenya and because they have been vaccinated against smallpox, respectively. These findings demonstrate the need to expose teachers to the anticipated side effects of the mpox vaccine as well as to provide professional information regarding mpox vaccination. Such actions are consistent with the findings of other studies reporting that understanding the potential side effects of a vaccine helps individuals feel more informed, reduces anxiety, and increases trust in the vaccine (Tuckerman et al. 2022). Educating the population by leveraging professional information about vaccines improves vaccine uptake and reduces vaccine hesitancy. Provision of professional vaccine information, which has been proven to alleviate vaccine hesitancy, includes circulating information regarding vaccine type, vaccine indications and usage, dosage and administration, efficacy, contraindications and the vaccine safety profile, inter alia (Jens et al. 2023). This study recommends providing professional mpox information to teachers in Kenya. Observational studies indicate that smallpox vaccination is highly effective in preventing mpox, with an efficacy rate as high as 85 %. However, the global discontinuation of smallpox vaccination in 1981 implies insufficient immunity against mpox among individuals younger than 40 years. In this study, 34 participants aged over 45 years, representing 2.90% of all respondents, indicated that they would hesitate to receive mpox vaccination because they had been vaccinated against smallpox. There is a need to educate school communities that immunity from the smallpox vaccine wanes with time and that vaccine protection against smallpox lasts for 3-5 years (Jon. 2001). Conclusions This study identified gaps in mpox knowledge and attitudes toward mpox vaccine among teachers which could impede successful mpox vaccination programs targeting school communities in Kenya. The study reported a high mpox vaccine hesitancy rate of more than 49 % among the participants and further highlighted factors that would contribute to mpox vaccination hesitancy. Therefore, there is a need for improving teachers’ mpox knowledge, especially by focusing on the mpox cure, symptoms and routes of transmission. It is highly recommended to implement diverse educational programs to improve attitudes toward mpox vaccination and decrease hesitancy among teachers in Kenya. The suggested policies could ensure successful roll out of mpox vaccination and in the positioning of teachers for the dissemination of mpox information in school communities in Kenya. Declarations Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This study did not receive funding Acknowledgments We gratefully acknowledge the study participants without whom this survey would not have been possible. We remain indebted to all the Teachers’ Service Commission Sub County Directors who were instrumental in ensuring the distribution of the online questionnaires to the respondents. This study was reviewed and approved by the Pwani University Ethics Review Committee and assigned reference number: ISERC/PU-STAFF/005/2024. All participants provided written informed consent prior to participation after being informed of the study’s objectives, procedures, potential risks, and their right to withdraw at any time without penalty. The study involved adult participants and all research procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki and the Pwani University Research Ethics Guidelines References Africa CDC (2024) Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent. https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security mobilizing-resources-across-the-continent/ Africa CDC (2024) Outbreak Report, 30 TH JULY 2024: Mpox Situation in Africa. https://africacdc.org/disease-outbreak/mpox-situation-in-africa/ Amer FA, Nofal HA, Gebriel MG, Bedawy AM, Allam AA, Khalil HES, Elahmady M, Nofal H, Saeed MA, Shaltout SW (2024) Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study. Front Cell Infect Microbiol 14:1339352. https://doi:10.3389/fcimb.2024.1339352. Awoyomi OJ, Njoga EO, Jaja IF, Oyeleye FA, Awoyomi PO, Ibrahim MA, Saulawa MA, Galadima HB, Rowaiye AB, Olasoju TI (2023) Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences. PLoS One 18(3): e0283571. https://doi:10.1371/journal.pone.0283571. Awoyomi OJ, Njoga EO, Jaja IF, Oyeleye FA, Awoyomi PO, Ibrahim MA, Saulawa MA, Galadima HB, Rowaiye AB, Olasoju TI (2023) Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences. PLoS One 18(3): e0283571. https://doi:10.1371/journal.pone.0283571. Baldwin AS, Tiro JA, Zimet GD (2023) Broad perspectives in understanding vaccine hesitancy and vaccine confidence: an introduction to the special issue. J Behav Med 46(1-2):1-8. https://doi:0.1007/s10865-023-00397-8. Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM (2023) Mpox respiratory transmission: the state of the evidence. Lancet Microbe 4(4): e277-e283.https://doi:10.1016/S2666-5247(23)00034-4 Berry MT, Khan SR, Schlub TE (2024) Predicting vaccine effectiveness for mpox. Nat Commun 15;3856. https://doi.org/10.1038/s41467-024-48180-w Cabanillas B, Murdaca G, Guemari A, Torres MJ, Azkur AK, Assoy E, Vitte J, de Las Vecillas L, Giovannini M, Fenandez-Santamaria R, (2023) A compilation answering 50 questions on monkeypox virus and the current monkeypox outbreak. Allergy 78(3):639-62. https://doi:10.1111/all.15633. Cataldi JR, Kerns ME, O'Leary ST (2020) Evidence-based strategies to increase vaccination uptake: a review. Curr Opin Pediatr 32(1):151-159. https://doi:10.1097/MOP.0000000000000843. Christodoulidou MM, Mabbott NA (2023) Efficacy of smallpox vaccines against Mpox infections in humans. Immunother Adv 3(1). https://doi:10.1093/immady/itad20. David BO, Ojima ZW, Sandra CF, Oluwafemi SO, Chibuike SA, Nifemi FO, Aanuduwapo CD (2024) Strengthening Africa’s response to Mpox (monkeypox): insights from historical outbreaks and the present global spread.SOH:100085. https://doi.org/10.1016/j.soh.2024.100085 Del RC, Malani PN (2022) Update on the Monkeypox outbreak. Jama. 328 (10): 921-22. https://doi:10.1001/jama.2022.14857 Diaz Ruiz C (2023) Disinformation on digital media platforms: A market-shaping approach. New Media & Society. https://doi.org/10.1177/14614448231207644 European Commission (2024) Mpox: HERA to donate over 215,000 vaccine doses to Africa CDC amid urgent outbreak. https://health.ec.europa.eu/latest-updates/mpox-hera-donate-over-215000-vaccine-doses-africa-cdc-amid-urgent-outbreak-2024-08-14_en Fahima A, Tahira BH, Fahana A, Aurpy D, Shanta A, Sadia M, Abdullahi AM, Saif-Ur- Rahman KA (2023) Effect of prior immunization with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol 33(4): e24444. https://doi.org/10.1002/rmv.2444 Jahromi AS, Jokar M, Sharifi N, Kashkooli S, Rahmanian K, Rahmanian V (2024) Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis. Int Health 16(5):487-498. https://doi:10.1093/inthealth/ihad094 Jens E, Lennart CK, Henrike S (2023) How to reduce vaccination Hesitancy? The relevance of evidence and its communicator. Vaccine 41(27):3964-75. https://doi.org/10.1016/j.vaccine.2023.03.026 Jon C (2001) Smallpox vaccinations: How much protection remains?. Science 294(5544):985. https://doi.org/10.1126/science.294.5544.985 Kelly C, Andrea M, McCollum, Chistine MH, Benjamin M, Joelle K, Robert SL, Toutou L, Beatrice N, Elisabeth P (2023) Updating reproduction Number Estimates for Mpox in the Democratic Republic of Congo Using Surveillance Data. Am J Trop Med Hyg 110(3):561-68. https://doi.org/10.4269/ajtmh.23-0215. Kugelman JR, Johnston SC, Mulembakani PM, Kisalu N, Lee MS, Koroleva G, McCarthy SE, Gestole MC, Wolf ND, Fair JN (2014) Genomic variability of monkeypox virus among humans, Democratic Repulic of the Congo. Emerg Infect Dis 20 (2):232-9. https://doi:10.320/eid2002.130118. Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, Kimball S, El-Mohandes A (2021) A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 27(2):225-228. https://doi:10.1038/s41591-020-1124-9. Lounis M, Hamimes A, Dahmani A (2024) Assessment of Monkeypox (MPOX) Knowledge and Vaccination Intention among Health and Life Sciences Students in Algeria: A Cross-Sectional Study. Infect Dis Rep 16(2):170-180. https://doi:10.3390/idr16020013. Lu J, Xing H, Wang C (2023) Mpox (formerly monkeypox): pathogenesis, prevention and treatment. Sig Transduct Target Ther 8, (458). https://doi.org/10.1038/s41392-023-01675-2 Mercy K, Tibebu B, Fallah M (2024) Mpox continues to spread in Africa and threatens global health security. Nat Med (30)1225–1226. https://doi.org/10.1038/s41591-024-02862-6 Nicaise N, Ngashi N, Morenike OF, Jean MY, Fiona B, Salam AG, Moeti M, Jean K (2024) Africa's mpox strategic preparedness and response plan: a coordinated continental effort to boost health security. The Lancet Global Health 0 (0). https://doi.org/10.1016/S2214-109x(24)00464-9. Petrichko S, Kindrachuk J, Nkamba D, Halbrook M, Merritt S, Kalengi H, Kamba L, Beya M, Hoff NA, Luhata C, Kaba DK, Rimoin AW (2024) Mpox Vaccine Acceptance, Democratic Republic of the Congo. Emerg Infect Dis 30(12). https://doi:10.3201/eid3012.241226. Piltch-Loeb R, Savoia E, Goldberg B, Hughes B, Verhey T, Kayyem J, Miller-Idriss C, Testa M (2021) Examining the effect of information channel on COVID-19 vaccine acceptance. PLoS One 16(5):e0251095. https://doi:10.1371/journal.pone.0251095. Raosoft Inc (2004) Raosoft Sample Size Calculator. Available from: https://www.raosoft.com/samplesize.html Tanashat M, Altobaishat O, Sharaf A, Hossam El Din Moawad M, Al-Jafari M, Nashwan AJ (2024) Assessment of the knowledge, attitude, and perception of the world's population towards monkeypox and its vaccines: A systematic review and descriptive analysis of cross-sectional studies. Vaccine X 20:100527. https://doi:10.1016/j.jvacx.2024.100527 Teachers Service Commission (2023) Strategic Plan for 2023-2027 Available from: https://www.tsc.go.ke/index.php/downloads-b/file/1961-tsc-strategic-plan-2023-2027 The Nation Media (2024) Schools turn death traps due to lack of space and facilities. [Accessed on Aug 24]. https://nation.africa/kenya/news/education/schools-turn-death-traps-due-to-lack-of-space-and-facilities--4530646 Tuckerman J, Kaufman J, Danchin M (2022) Effective Approaches to Combat Vaccine Hesitancy. Pediatr Infect Dis J.41(5): e243-e245. https://doi:10.1097/INF.0000000000003499. UNESCO (2020) The Kenya Ministry of Education’s response to the COVID-19 pandemic.https://unesdoc.unesco.org/ark:/48223/pf0000381092/PDF/381092eng.pdf.multi UNICEF (2024) Kenya Mpox Level 3 Emergency. https://www.unicef.org/media/163471/file/Kenya-Humanitarian-Situation-Report-No.-1-(Level-3-Mpox),-03-October-2024.pdf WHO (2023) Director-General’s opening remarks at the media briefing; [Accessed 2024 Aug 12]. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening -remark-at-the-media-briefing---11-may-2023 WHO (2023) 2022-23 Mpox (Monkeypox) outbreak: global trends; [Accessed 2024 June 30]. https://worldhealthorg.shinyapps.io/mpx_global/. WHO (2024) Mpox. https://www.who.int/news-room/fact-sheets/detail/mpox WHO (2022) Multi-country outbreak of Mpox. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20221214_mpox_external-sitrep-12-.pdf WHO (2015) Summary WHO SAGE conclusions and recommendations on Vaccine Hesitancy. https://www.who.int/docs/default-source/immunization/demand/summary-of-sage-vaccinehesitancy-en.pdf?sfvrsn=abbfd5c8_2 WHO (2015) Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes WHO (2023) WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines. https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccines-SAGE-Prioritization-2023.1 WHO Africa Regional Office (2024) Interim public health advice for mpox-related prevention and control measures in school settings. https://www.afro.who.int/sites/default/files/202410/MpoxSchool_InterimPHA_27Sept2024.pdf Yang X, Hu C, Yang X, Yang X, Hu X, Wang X, Liu C, Yuan Y, Du S, Wang PG (2023) Evaluation and comparison of immune responses induced by two mpox mRNA vaccine candidates in mice. J Med Viorl 95(10): e29140. https://doi:10.1002/jmv.29140. Yang Y, Zhang W, Han B, Meng H, Wang J, Wu K, Fu L, Wang B, Jiang X, Li Q (2024) Mpox knowledge and vaccination hesitancy among healthcare workers in Beijing, China: A cross-sectional survey. Vaccine X 16:100434. https://doi:10.1016/j.jvacx.2024.100434. Additional Declarations No competing interests reported. Supplementary Files QUESTIONNAIREUSEDINTHISSTUDY.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5511275","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528892560,"identity":"8dd2c55c-f9a0-4458-aa82-0cc3befef6b2","order_by":0,"name":"Patrick Mutua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYJACZiDm4QexEgqI1ADWItkA0mJAghYGgwNgkggN5uznj24ubDssY3x+deKHBwYM8vxiB/BrsexJZrs9s+0wj9mNt5slgA4znDk7Ab8WgwNALbxtaUAtZzeAtCQY3Cak5fxjiBbjGWc3/yBOyw2wLTY8Bvy924izxXLGY7PbM87Z8Ejc4N1mkWAgQdgv5vyJz24XlEnY8/ef3XzzR4WNPL80IYfBWRJglRL4laNq4T9AWPUoGAWjYBSMTAAADW5CA9tC7uAAAAAASUVORK5CYII=","orcid":"","institution":"Pwani University","correspondingAuthor":true,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Mutua","suffix":""},{"id":528892561,"identity":"2c66ef66-4aa5-4b91-95e6-c93a853a2340","order_by":1,"name":"Michael Gicheru","email":"","orcid":"","institution":"Kenyatta University","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Gicheru","suffix":""},{"id":528892562,"identity":"32f14292-9d20-4231-b63c-a3fd035c7d55","order_by":2,"name":"Joshua Mutiso","email":"","orcid":"","institution":"Kenyatta University","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Mutiso","suffix":""},{"id":528892563,"identity":"8df79714-b002-47f0-adfe-15cdffb292bc","order_by":3,"name":"Erick Seremu","email":"","orcid":"","institution":"Pwani University","correspondingAuthor":false,"prefix":"","firstName":"Erick","middleName":"","lastName":"Seremu","suffix":""}],"badges":[],"createdAt":"2024-11-23 18:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5511275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5511275/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93573824,"identity":"fa04a522-67da-438a-a8df-2059550f6bdb","added_by":"auto","created_at":"2025-10-15 09:13:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65375,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of information sources related to mpox disease. The key shows different sources of mpox information.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5511275/v1/f70461cd13d564710e8e1f97.jpg"},{"id":93571679,"identity":"eb91139b-e898-4113-a62a-cc6328a06c95","added_by":"auto","created_at":"2025-10-15 09:05:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":86652,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for mpox vaccine hesitancy among the sampled teachers in Kenya\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5511275/v1/00374096b967accb046f7b48.jpg"},{"id":93574961,"identity":"cfa16649-a945-4bec-9504-814eb468f4f2","added_by":"auto","created_at":"2025-10-15 09:21:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5511275/v1/700f4b22-6ca8-478e-b855-e24c9bd3216e.pdf"},{"id":93573825,"identity":"ceec9036-06e2-4e13-9e5a-0adb4a3a3955","added_by":"auto","created_at":"2025-10-15 09:13:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26661,"visible":true,"origin":"","legend":"","description":"","filename":"QUESTIONNAIREUSEDINTHISSTUDY.docx","url":"https://assets-eu.researchsquare.com/files/rs-5511275/v1/0650ca7ebf6584b1724a76ce.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mpox knowledge, Attitudes towards Mpox vaccine and Hesitancy for Mpox vacciantion among Teachers in Kenya","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMpox disease, formerly known as Monkeypox, is a zoonotic disease caused by the mpox virus which belongs to the genus \u003cem\u003eOrthopoxvirus\u003c/em\u003e and the family \u003cem\u003ePoxviridae\u003c/em\u003e (Kugelman et al. 2014; Yang et al. 2023). The virus was first isolated in monkeys in 1958 but the first human case was reported in the Congo in 1970 (Cabanillas et al. 2023). Central Africa, particularly the Congo, remains the epicenter of infection (Kelly et al. 2023). In 2022, the World Health Organization (WHO) declared the mpox outbreak a Public Health Emergency of International Concern (PHEIC) after 110 countries were affected (WHO. 2023). The WHO lifted the PHEIC in 2023 after cases of mpox infections declined substantially, especially in the Global North\u003csup\u003e.\u003c/sup\u003e (WHO. 2023). However, the WHO lifted the PHEIC despite increasing cases of mpox outbreaks in Africa. In 2022, for example, the Africa Centers for Disease Control (Africa CDC) and Prevention reported an estimated 8,000 mpox cases, which increased by approximately 78.5 % to 15,000 cases in 2023 and 18,000 cases in August 2024 (Africa CDC. 2024). On 13\u003csup\u003eth\u003c/sup\u003e August 2024, the Africa CDC and Prevention issued a Public Health Emergency of Continental Concern in response to rapid the spread of mpox cases reported across 16 African countries (Africa CDC. 2024). Kenya reported the first mpox case on 31\u003csup\u003est\u003c/sup\u003e July 2024, and, as of October 2024, 12 mpox cases had been confirmed in the country (UNICEF. 2024). Mpox transmission is a rapidly evolving aspect of this disease. While the natural hosts of the mpox virus are rodents and monkeys and account for zoonotic transmission, recent studies have shown increased human-to-human mpox transmission mainly through sexual intercourse, especially among men who have sex with men and through human-to-human contact, whose cases have increased due to rapid population movements and globalization (Del and Malani. 2022). Mpox transmission has also been reported to take place vertically from infected pregnant women to newborns (Del and Malani. 2022). Additionally, transmission also occurs by inhaling respiratory droplets from infected patients (Beeson et al. 2023). Currently, there is no known cure for mpox, and vaccination remains the most viable strategy for preventing widespread outbreaks of the disease (Berry et al. 2024). The mpox virus shares surface antigens with the smallpox virus. On this basis, the smallpox vaccine is reported to confer cross-antigenic protection of between 35% and 85 % against mpox (Christodoulidou and Mabbot. 2023; Fahima et al. 2023). The withdrawal of the smallpox vaccine in 1981 implies that few people have been vaccinated. Moreover, the smallpox vaccine confers immunity against \u003cem\u003eOrthopoxviruses\u003c/em\u003e for only 3 \u0026ndash; 5 years (Jon. 2001). The Africa CDC and Prevention is currently collaborating with the European Commissions\u0026rsquo; Health Emergency and Bavarian Nordic to secure over 215, 0000 doses of the MVA-BN vaccine to vaccinate against mpox on the continent (European Commission. 2024). However, the increasing number of mpox outbreaks on the continent may render the requested dosses inadequate, and an advisory to adopt the WHO guidelines of distributing vaccines in the context of limited supply, as was the case with COVID-19 vaccines, may be sought (WHO. 2023). While studies on mpox knowledge and attitudes toward mpox vaccination have reported a substantial reduction in the spread of infection and in the alleviation of vaccine hesitancy through improved public knowledge of mpox and attitudes towards the mpox vaccine, such studies have been conducted primarily in nonendemic regions and are limited in Africa (Jahromi et al. 2024; David et al. 2024). Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination services, is listed among the ten global health threats by the WHO (WHO. 2015) and is the main reason for the clustering of endemics such as mpox and Ebola in central Africa (Mercy et al. 2024). In 2022, the Congo and Nigeria were the African nations most affected by the mpox outbreak (WHO. 2022). A survey of non-health and health professionals in the Congo reported mpox vaccination acceptance rate of 61 % (Petrichko et al. 2024). In Nigeria, a study reported mpox knowledge score of 60.5 % among healthcare providers, however, the attitude score towards mpox vaccination was 28.9 % (Awoyomi et al. 2023). In Egypt, a report showed that half of healthcare providers sampled had adequate mpox knowledge, but the perception of mpox vaccination was moderate (Amer et al. 2024). Current research on mpox knowledge and attitudes toward vaccination among non-health care providers in Africa is scarce. A systematic review on the assessment of mpox knowledge and attitudes toward mpox vaccination in the world\u0026rsquo;s population reported that 54 % of the subjects studied had poor mpox knowledge whereas 35 % were not willing to receive mpox vaccine (Tanashat et al. 2024). Research has demonstrated that HIV patients, pregnant women, patients on immunosuppressive drugs and children aged 15 years and younger are the most susceptible populations (Lu et al. 2023). An assessment of the risks posed by mpox outbreaks among children prompted the WHO Africa Region office to issue an interim report on public health advice for mpox-related prevention and control measures in school settings (WHO Africa Region Office. 2024). In the report, teachers are expected to identify, isolate and support students with symptoms related to mpox by referring them to healthcare providers for medical attention (WHO Africa Region Office. 2024). According to the Teachers Service Commission (TSC) of Kenya, the government agency that employs teachers in the country, the basic education school community comprises 222, 000 teachers working in 32,594 primary schools and 128,000 instructors who teach in 10,482 secondary schools (TSC. 2023). Additionally, the school communities have an estimated 10.4 million learners aged between 6-13 years and 3.9 million learners aged between 13 -18 years attending primary schools and secondary institutions, respectively (TSC. 2023). The basic education learning ecosystem in Kenya is vulnerable to the mpox outbreak, not only because the students are within the vulnerable age group, but also because many schools are congested, and have an inadequate supply of water and insufficient sanitation infrastructure. Furthermore, most institutions are far from medical facilities (Nation Media. 2024; UNESCO. 2020). Additionally, an estimated 70 % of students commute to school from their homes, increasing likelihood of transmitting mpox disease from communities to institutions (UNESCO. 2020). To effectively curb mpox cases in school settings, baseline data on teachers\u0026rsquo; knowledge of mpox and attitudes toward mpox vaccination in Kenya are needed. The gaps identified can be addressed through public education awareness of mpox disease and by improving teachers\u0026rsquo; attitudes toward mpox vaccination before the implementation of mpox vaccination programs targeting school communities in the Republic of Kenya.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy setting, design and ethical considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross‑sectional study to examine knowledge of mpox and attitudes toward mpox vaccination as well as identify factors associated with mpox vaccine hesitancy among teachers in Kenya. The study was conducted from 21\u003csup\u003est\u003c/sup\u003e August to 3\u003csup\u003erd\u0026nbsp;\u003c/sup\u003eOctober 2024 and in accordance with the Helsinki declarations of 1975 as revised in 2013. The TSC Sub County directors, who are in charge of teacher management in the 300 sub counties in Kenya, were first taken through the study design and objectives by the authors. The study objectives were then explained to the participants via virtual meetings that were conducted by the TSC Sub Cunty Directors at the beginning of the study period. The participants were required to read and agree to provide informed consent before completing the online questionnaire. Participants who did not agree to provide informed consent were not allowed to proceed with the study. The potential risks and benefits of the study were well explained. The respondent\u0026rsquo;s confidentiality was assured by the collection of data that were completely anonymous and that no personal identifiable information was collected. The respondents were required to consent to voluntary participation and were free to choose to not participate or end their participation at any time of the study. The participants were free to contact the study authors if they had any questions or comments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sampled and included registered teachers employed by the TSC and working in primary and secondary schools in Kenya. Registered but unemployed teachers were not included in the study. Furthermore, only teachers who read and agreed to provide informed consent and submitted their responses to the online questionnaire on time were included in the final study sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are 350, 000 teachers employed by the TSC in more than 32,000 schools in Kenya (TSC. 2023). The\u0026nbsp;sample size was determined using the online Raosoft sample size calculator (Raosoft. 2004). For a population of 350,000 teachers with a 95% confidence interval and a 5 % margin error, the minimum number of the estimated sample was 384. As this is the first cross-sectional study of mpox knowledge and perceptions of the mpox vaccine and hesitancy factors involving teachers in Kenya, the sample size was increased by about 4-fold to ensure that a representative sample obtained an estimated maximum sample size of approximately 1,500. To ensure an inclusive sample of teachers from all parts of the country, respondents were required to indicate their schools\u0026rsquo; sub-county in the questionnaire for a random proportional distribution of the submitted questionnaires on the basis of the number of teachers in each of the 300 sub-counties.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and analysis \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA questionnaire that was used in a previous study by Yang et al. (2024) was slightly modified to reflect respondents\u0026rsquo; sub counties and their awareness of mpox cases reported in Kenya at the time of the interview. The questionnaire was validated through a test-retest reliability method involving 185 randomly sampled teachers in Makueni County, Kenya. The questionnaire had four sections: The first section sought information on socio-demographic characteristics of the respondents, awareness of mpox cases reported in Kenya, and sources of mpox information. The second section contained 12 questions for assessing respondents\u0026rsquo; mpox knowledge whereas the third section included 6 questions for determining respondents\u0026rsquo; attitudes toward mpox vaccine. The fourth section had included a list of 10 hesitancy factors for participants to select from. Online questionnaires in Google forms were shared with TSC Sub County Directors for distribution to randomly selected teachers in Kenya. The questionnaires were coded, and the data collected were entered into an Excel file, which was imported into IBM SPSS Statistics 27 software for statistical analysis. A value of \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026le; 0.05 was considered significant. Categorical data are presented as frequencies and percentages. Continuous data were checked for normality and then presented as the means and standard deviations (SD) for normally distributed variables.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e(A)\u0026nbsp;Demographic characteristics of the respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1,549 participants submitted their responses; however, 410 questionnaires were excluded because they were incomplete, and, therefore, 1,139 questionnaires constituted the final sample representing a response rate of 75.9 % of the estimated sample size. The respondents included 672 males and 467 females accounting for 59 % and 41 % of the respondents, respectively. The median age group of the respondents was 35 - 44 years. More than 40 % of the sampled teachers had a certificate or diploma, 41 % had a degree certificate while 18.8 % had postgraduate qualifications. Primary and secondary school teachers comprised 59.35 % and 40.65 % of the respondents, respectively. More than 71 % of the participants were from day schools. \u0026nbsp;\u003cem\u003eTable 1\u003c/em\u003e shows summary of the respondents\u0026rsquo; demographic characteristics\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1\u003c/em\u003e: Demographic characteristics of the respondents\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003eFrequency (N=1139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e41.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e59.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e86.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e13.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eCertificate/Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e40.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e41.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e18.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e31.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e28.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e45 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e38.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eType of school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e59.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e40.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eSchool category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eDay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e71.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eBoarding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eDay/Boarding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e15.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eSubjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e43.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eArts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e17.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eLinguistics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e12.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003eScience/Math/Technical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e25.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003eExperience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e0-4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e18.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e23.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e10-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e15.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e15-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e9.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4%;\"\u003e\n \u003cp\u003e20 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.8%;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.6%;\"\u003e\n \u003cp\u003e32.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e(B)\u0026nbsp;Sources of mpox information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, more than 73 % of the participants acquired mpox information from digital portals and social media such as WhatsApp and Facebook. \u0026nbsp;More than one-fifth of the respondents obtained mpox information from traditional media including television, newspapers and radio. Approximately 2.19 % and 2.6 % of the participants obtained mpox information from communications with colleagues and friends and from other sources, respectively. Only 1.23 % of the sampled teachers obtained mpox information from employers (Figure 1). At the time of the interviews, more than 34 % (388/1139) of the respondents were not aware of the mpox cases reported in the country.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(C)\u0026nbsp;Respondents\u0026rsquo; knowledge of mpox disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 12 questions were used to assess respondents\u0026rsquo; knowledge of mpox disease. The mpox knowledge score was calculated as the proportion of correct responses and the quotient multiplied by 12. The mean mpox knowledge score was 8.2 (\u003cem\u003eSD\u003c/em\u003e=1.6), translating to mpox knowledge percentage score of 68.3 % (8.2/12). The median score was 8.6 and, therefore, an adequate mpox knowledge score was considered for values between 8.6 to 12. An estimated 86 % and 72 % of the respondents correctly answered that mpox was an infectious disease and was caused by a virus. More than 71 % of the participants correctly responded that people are susceptible to mpox. However, more than 52 % of the respondents incorrectly reported that mpox has a cure. The responses concerning mpox symptoms revealed that 29 % and 25 % of the participants were not aware that mpox can cause fatigue and fever, respectively. Additionally, 37 % and 27 % of the respondents incorrectly indicated that mpox does not cause swollen lymph nodes and headache, respectively. An estimated 39 % of the sampled teachers were not aware that mpox causes back or muscle aches. \u003cem\u003eTable 2\u003c/em\u003e shows summary of the responses obtained in each of the 12 questions\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2\u003c/em\u003e. Assessment of respondents\u0026rsquo; knowledge of mpox\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eS/No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eKnowledge Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 298px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N=1139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCorrect response (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eIncorrect response (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox is infectious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e987 (86.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e152 (13.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox is caused by a virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e821 (72.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e318 (27.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003ePeople are susceptible to Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e809 (71.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e330 (28.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eThere is no treatment for Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e546 (47.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e593 (52.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eThere is a safe Mpox vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e478 (41.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e661 (58.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox can cause fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e853 (74.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e286 (25.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox can cause headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e829 (72.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e310 (27.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox can cause fatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e807 (70.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e332 (29.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox cause swollen lymph nodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e737 (64.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e402 (35.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox can cause skin rash\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e952 (83.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e187 (16.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eMpox cause back/muscle aches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e692 (60.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e447 (39.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eRoutes of transmission of Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e869 (76.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e270 (23.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e(D) Respondents\u0026rsquo; attitudes toward the mpox vaccine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix questions were used to determine respondents\u0026rsquo; attitudes toward the mpox vaccine. An attitude score was derived by calculating the number of appropriate responses to the 6 questions and a mean attitude score of 3.7 (SD=0.72), translated to an average attitude percentage score of 62 % (3.7/6), was obtained. The median attitude score was 3.4. An adequate attitude score was considered for values between 3.4 and 6, whereas poor attitude scores ranged from 0 to 3.3. More than 81 % of the participants indicated that it is important to be vaccinated against mpox. However, when asked \u0026ldquo;would you be willing to get vaccinated against mpox\u0026rdquo;, the percentage dropped to 50.22 % of the participants who would agree to be vaccinated. The respondents had inadequate attitude scores of 3.3 and 3.0 in terms of vaccine safety and in willing to get vaccinated, respectively. Additionally, an inadequate attitude score of 3.2 for the willingness of participants to be vaccinated if the mpox vaccine was provided for free was reported (3.2). \u003cem\u003eTable 3\u003c/em\u003e presents a summary of the mpox attitude scores.\u003c/p\u003e\n\u003cp\u003eTable 3. Assessment of participants\u0026rsquo; perceptions of the mpox vaccine\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eS/No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eAttitude Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N=1139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCorrect Response (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eIncorrect Response (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eDo you think it is important to get vaccinated against Mpox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e932 (81.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e207 (18.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eMpox vaccine is safe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e635 (55.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e504 (44.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eMpox vaccine is effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e646 (56.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e493 (43.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eMpox vaccination of teachers is important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e785 (68.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e354 (31.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eWould you like to be vaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e572 (50.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e567 (49.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eWould you like to be vaccinated against Mpox if the vaccine is free\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e615 (53.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e524 (46.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e(E) \u0026nbsp; \u0026nbsp;Association between groups and their level of mpox knowledge and attitudes toward mpox vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA chi-square test was applied to determine the statistical associations between background characteristics (age, gender, marital status, level of education and type of school a teacher taught) and their level of mpox knowledge as well as their attitudes toward mpox vaccination. There was no significant (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e˃ 0.05) association between any of the respondents\u0026rsquo; background characteristics and their level of mpox knowledge or their attitudes toward mpox vaccination. In order to evaluate the correlation between mpox knowledge and attitude towards mpox vaccination, a \u003cem\u003ePhi\u003c/em\u003e test was conducted and a value of 0.077 (\u003cem\u003eP\u003c/em\u003e=0.05) was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(F) Demographic characteristics of participants and their willingness to receive mpox vaccine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe acceptance group represented more than 50 % (572/1139) of the respondents whereas 49.78 % of the participants (567/1139) composed the hesitant group. A chi-square test was used to determine the differences in the distribution of vaccination hesitancy among characteristics which included age, gender, level of education, marital status, type of school, category of school and experience. The results revealed that only the level of education was significantly different (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.03) between mpox vaccine acceptance and hesitancy. The rates for vaccine acceptance and vaccine hesitancy for certificate/diploma participants were 54.8 % and 45.17 %, respectively. For undergraduates, the acceptance and hesitation rates were 46.48 % and 53.51 %, respectively. The postgraduate vaccine acceptance and hesitant rates were 48.6 % and 51.4 % respectively (Table 4). A logistic regression analysis affecting mpox vaccine acceptance, (1= vaccine acceptance, 0= vaccine hesitancy), indicated that certificate/diploma respondents were 1.534 times more likely to be willing to be vaccinated against mpox (OR=1.534, 95 % CI: 0.165-6.688, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). \u0026nbsp;\u003cem\u003eTable 4\u003c/em\u003e presents a summary of the participants\u0026rsquo; background characteristics and mpox vaccine acceptance and hesitation rates\u003c/p\u003e\n\u003cp\u003eTable 4. A chi square test of the significance of the background characteristics of participants on their mpox vaccine acceptance/hesitance \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eWillingness to be Mpox vaccinated (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHesitancy against Mpox vaccination (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cem\u003eP values\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e187 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e175 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e151 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e174 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e45 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e227 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e214 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e229 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e238 (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e343 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e329 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCert/Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e250 (54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e206 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e218 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e251 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e104 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e110 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e488 (49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e492 (50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e84 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e75 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eType of school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e352 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e324 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e220 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e243 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCategory of school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e418 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e395 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDay/Boarding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e88 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e88 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBoarding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e66 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e84 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eExperience (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e101 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e109 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e136 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e136 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e84 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e90 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e50 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e59 (54,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026ge;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e189 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e185 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e(G) Mpox hesitancy factors among the participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn the basis of the WHO 3Cs (convenience, confidence, complacency) vaccine hesitancy model (WHO. 2015), participants were provided with a list of 10 hesitancy factors to choose from. As shown in Figure 2, more than 62 % of the respondents hesitate from receiving the mpox vaccine because of they are worried about the side effects of the vaccine. More than 18 % and 16 % of the participants would hesitate mpox vaccination because of a failure to receive professional advice and because they were concerned about vaccine effectiveness, respectively. Approximately, 2.9 % of the participants would hesitate to be vaccinated because they had been vaccinated against smallpox whereas more than 1.4 % of the participants would hesitate to receive mpox vaccination because they believed that mpox was not a serious infection. Figure 2 shows a summary of the reasons for hesitancy toward the mpox vaccine among the respondents.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOn 13\u003csup\u003eth\u003c/sup\u003e August 2024, the Africa CDC and Prevention declared mpox a Public Health Emergency of Continental Concern. The reason for the declaration was to call for a unified, continent-wide responses to the rapidly spreading disease and for individual governments to put measures in place to stop any further outbreak of the infection (European Commission. 2024). In September 2024, the WHO released a report to provide guidance on measures to reduce possible mpox outbreaks in schools. The report recommends that teachers identify, isolate and refer learners showing mpox related symptoms to medical facilities (WHO Africa Region Office. 2024). At the beginning of the survey, which was a month after the first mpox case had been reported in Kenya, 34 % of the participants were not aware of mpox cases reported in the country. With respect to the sources of mpox information, more than 73 % of the participants obtained mpox information from digital portals such as WhatsApp and Facebook. While the accuracy of the mpox information disseminated via digital portals to the respondents was not confirmed by the current study, it is important to note that mpox disinformation and misinformation have been reported to be spread through digital portals (Diaz. 2023). Disease disinformation and misinformation have been associated with vaccine hesitancy (Baldwin et al. 2023). Most employees trust information about diseases if the source of the information is from the employer or from collaborations of the employer with healthcare providers (Lazarus et al. 2021). In this study, only 1.23 % of the participants had received mpox information from the TSC. Therefore, there is need for the TSC to collaborate with healthcare providers to improve the dissemination of mpox information to teachers. In Kenya, government agencies have traditional media including television, newspapers and radio to transmit COVID-19 information. A global survey on the use of traditional media reported reduced COVID-19 vaccination hesitancy in situations where governments and other public health providers effectively used television, newspapers and radio for the dissemination of COVID-19 disease information (Piltch-Loeb et al. 2021). In this survey, more than 20 % of the respondents had received mpox information through traditional media. Improving population knowledge of mpox disease through public education is critical for ensuring a high acceptance rate of the mpox vaccine (Cataldi et al. 2020). In Africa, studies on mpox knowledge and attitudes toward mpox vaccine among non-health professionals are few. Furthermore, studies have reported inadequate mpox knowledge and attitude towards mpox vaccines on the continent (Nicaisei et al. 2024). In a study involving health and non-health professionals in the Congo, a mpox vaccine acceptance rate of 61 % was reported, however, more than 17 % of the respondents had no knowledge related to mpox (Petrichko et al. 2024). In Algeria, a study involving health and life sciences students at universities found a moderate mpox vaccination acceptance level of 48.5 % and a low level of mpox knowledge of 42.8 % (Lounis et al. 2024). In Nigeria, only 28.9 % of participants in a study involving 1,452 respondents had adequate mpox knowledge and positive perceptions of the mpox vaccine (Awoyomi et al. 2023). We report, for the first time in Kenya, the findings of this study involving 1,139 sampled teachers who recorded mpox knowledge and attitude scores toward mpox vaccination of 68.3% and 62 %, respectively. Significant mpox knowledge gaps were identified in areas related to mpox treatment, the availability of a safe mpox vaccine and mpox symptoms. While more than 86 % and 72 % of the respondents knew that mpox is an infectious disease caused by a virus, respectively, only 47.94 % knew that there is no cure for mpox. More than 58 % of the participants were not aware of the existence of a safe mpox vaccine. These knowledge gaps are likely to impede the successful roll out of mpox vaccination among teachers and which can be a barrier in positioning teachers for the dissemination of mpox information and mpox vaccination in school communities in Kenya. The initial prodromal symptoms of mpox include swollen lymph nodes, fever, skin rash, and muscle aches (WHO. 2024). The respondents had inadequate knowledge of mpox symptoms. For example, more than 35 % of the participants, were not aware that mpox can cause swollen lymph nodes. Additionally, more than 39 % and 16 % of the participants lacked knowledge related to muscle aching and skin rash as mpox symptoms, respectively. These knowledge gaps in mpox symptoms may render teachers unable to identify, isolate and support mpox affected learners as stipulated in the WHO interim report on student support by teachers in the context of the mpox outbreak in school settings (WHO Africa Region Office. 2024). The respondents had inadequate attitudes toward the mpox vaccine. Only 55.75 % and 56.72 % of the participants believed that the mpox vaccine was safe and effective, respectively. Whereas an estimated 81 % of the respondents agreed it is important to be vaccinated against mpox, this dropped to just over 50 % of the participants when they were asked if they would personally agree to be vaccinated. The negative attitude toward mpox vaccination may be a barrier to the successful roll out of mpox vaccination programs targeting teachers in Kenya and, therefore, the need to launch comprehensive education strategies targeting changes in teachers\u0026rsquo; attitudes toward the mpox vaccine. This study revealed a weak association between mpox knowledge and attitudes toward the mpox vaccine. Therefore, multifaceted educational and vaccination campaign programs should aim at improving the association between teachers\u0026rsquo; mpox knowledge and their attitudes toward mpox vaccination. We found a significant association between respondents\u0026rsquo; level of education and the mpox vaccine acceptance rate, especially among the certificate and diploma respondents. More than 40 % of the participants had a certificate/diploma as the highest level of qualification. Additionally, 430 participants, representing more than 94 % of the certificate/diploma respondents, were sampled from primary schools. In Kenya, more than 62 % of teachers work in primary institutions (TSC. 2023). Furthermore, there are more than 10 million learners in primary schools and many of the institutions are congested, lack sufficient sanitation facilities and are mostly day schools with more than 71 % of the learners commuting to their schools (UNESCO. 2020). These factors predispose primary school communities to mpox disease outbreaks. The government and healthcare providers should, therefore, leverage the high mpox vaccine acceptance rate among certificate/diploma primary school teachers and seek to further improve their mpox knowledge and attitudes toward the mpox vaccine. This will help ensure the successful initiation of mpox vaccination campaigns targeting teachers in Kenya. With reference to the WHO 3Cs (Convenience, Complacency, and Confidence) vaccine hesitancy model (WHO. 2015), more than 62 % and 18 % of the participants would hesitate to receive the mpox vaccination because they were worried about the side effects of the vaccine and not getting professional advice about the vaccine, respectively. Additionally, more than 3% and 2.9 % would hesitate to receive mpox vaccination because mpox will not be endemic in Kenya and because they have been vaccinated against smallpox, respectively. These findings demonstrate the need to expose teachers to the anticipated side effects of the mpox vaccine as well as to provide professional information regarding mpox vaccination. Such actions are consistent with the findings of other studies reporting that understanding the potential side effects of a vaccine helps individuals feel more informed, reduces anxiety, and increases trust in the vaccine (Tuckerman et al. 2022). Educating the population by leveraging professional information about vaccines improves vaccine uptake and reduces vaccine hesitancy. Provision of professional vaccine information, which has been proven to alleviate vaccine hesitancy, includes circulating information regarding vaccine type, vaccine indications and usage, dosage and administration, efficacy, contraindications and the vaccine safety profile, \u003cem\u003einter alia\u003c/em\u003e (Jens et al. 2023). \u0026nbsp;This study recommends providing professional mpox information to teachers in Kenya. Observational studies indicate that smallpox vaccination is highly effective in preventing mpox, with an efficacy rate as high as 85 %. However, the global discontinuation of smallpox vaccination in 1981 implies insufficient immunity against mpox among individuals younger than 40 years. In this study, 34 participants aged over 45 years, representing 2.90% of all respondents, indicated that they would hesitate to receive mpox vaccination because they had been vaccinated against smallpox. There is a need to educate school communities that immunity from the smallpox vaccine wanes with time and that vaccine protection against smallpox lasts for 3-5 years (Jon. 2001).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study identified gaps in mpox knowledge and attitudes toward mpox vaccine among teachers which could impede successful mpox vaccination programs targeting school communities in Kenya. The study reported a high mpox vaccine hesitancy rate of more than 49 % among the participants and further highlighted factors that would contribute to mpox vaccination hesitancy. Therefore, there is a need for improving teachers\u0026rsquo; mpox knowledge, especially by focusing on the mpox cure, symptoms and routes of transmission. It is highly recommended to implement diverse educational programs to improve attitudes toward mpox vaccination and decrease hesitancy among teachers in Kenya. The suggested policies could ensure successful roll out of mpox vaccination and in the positioning of teachers for the dissemination of mpox information in school communities in Kenya.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the study participants without whom this survey would not have been possible. We remain indebted to all the Teachers\u0026rsquo; Service Commission Sub County Directors who were instrumental in ensuring the distribution of the online questionnaires to the respondents. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Pwani University Ethics Review Committee and assigned reference number: ISERC/PU-STAFF/005/2024. All participants provided written informed consent prior to participation after being informed of the study’s objectives, procedures, potential risks, and their right to withdraw at any time without penalty. The study involved adult participants and all research procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki and the Pwani University Research Ethics Guidelines\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAfrica CDC (2024) Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent. https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security mobilizing-resources-across-the-continent/ \u003c/li\u003e\n\u003cli\u003eAfrica CDC (2024) Outbreak Report, 30\u003csup\u003eTH\u003c/sup\u003e JULY 2024: Mpox Situation in Africa. https://africacdc.org/disease-outbreak/mpox-situation-in-africa/ \u003c/li\u003e\n\u003cli\u003eAmer FA, Nofal HA, Gebriel MG, Bedawy AM, Allam AA, Khalil HES, Elahmady M, Nofal H, Saeed MA, Shaltout SW (2024) Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study. Front Cell Infect Microbiol 14:1339352. https://doi:10.3389/fcimb.2024.1339352. \u003c/li\u003e\n\u003cli\u003eAwoyomi OJ, Njoga EO, Jaja IF, Oyeleye FA, Awoyomi PO, Ibrahim MA, Saulawa MA, Galadima HB, Rowaiye AB, Olasoju TI (2023) Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences. PLoS One 18(3): e0283571. https://doi:10.1371/journal.pone.0283571. \u003c/li\u003e\n\u003cli\u003eAwoyomi OJ, Njoga EO, Jaja IF, Oyeleye FA, Awoyomi PO, Ibrahim MA, Saulawa MA, Galadima HB, Rowaiye AB, Olasoju TI (2023) Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders-Global public health consequences. PLoS One 18(3): e0283571. https://doi:10.1371/journal.pone.0283571. \u003c/li\u003e\n\u003cli\u003eBaldwin AS, Tiro JA, Zimet GD (2023) Broad perspectives in understanding vaccine hesitancy and vaccine confidence: an introduction to the special issue. J Behav Med 46(1-2):1-8. https://doi:0.1007/s10865-023-00397-8. \u003c/li\u003e\n\u003cli\u003eBeeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM (2023) Mpox respiratory transmission: the state of the evidence. Lancet Microbe 4(4): e277-e283.https://doi:10.1016/S2666-5247(23)00034-4 \u003c/li\u003e\n\u003cli\u003eBerry MT, Khan SR, Schlub TE (2024) Predicting vaccine effectiveness for mpox. Nat Commun 15;3856. https://doi.org/10.1038/s41467-024-48180-w \u003c/li\u003e\n\u003cli\u003eCabanillas B, Murdaca G, Guemari A, Torres MJ, Azkur AK, Assoy E, Vitte J, de Las Vecillas L, Giovannini M, Fenandez-Santamaria R, (2023) A compilation answering 50 questions on monkeypox virus and the current monkeypox outbreak. Allergy 78(3):639-62. https://doi:10.1111/all.15633. \u003c/li\u003e\n\u003cli\u003eCataldi JR, Kerns ME, O\u0026apos;Leary ST (2020) Evidence-based strategies to increase vaccination uptake: a review. Curr Opin Pediatr 32(1):151-159. https://doi:10.1097/MOP.0000000000000843. \u003c/li\u003e\n\u003cli\u003eChristodoulidou MM, Mabbott NA (2023) Efficacy of smallpox vaccines against Mpox infections in humans. Immunother Adv 3(1). https://doi:10.1093/immady/itad20. \u003c/li\u003e\n\u003cli\u003eDavid BO, Ojima ZW, Sandra CF, Oluwafemi SO, Chibuike SA, Nifemi FO, Aanuduwapo CD (2024) Strengthening Africa\u0026rsquo;s response to Mpox (monkeypox): insights from historical outbreaks and the present global spread.SOH:100085. https://doi.org/10.1016/j.soh.2024.100085 \u003c/li\u003e\n\u003cli\u003eDel RC, Malani PN (2022) Update on the Monkeypox outbreak. Jama. 328 (10): 921-22. https://doi:10.1001/jama.2022.14857 \u003c/li\u003e\n\u003cli\u003eDiaz Ruiz C (2023) Disinformation on digital media platforms: A market-shaping approach. New Media \u0026amp; Society. https://doi.org/10.1177/14614448231207644 \u003c/li\u003e\n\u003cli\u003eEuropean Commission (2024) Mpox: HERA to donate over 215,000 vaccine doses to Africa CDC amid urgent outbreak. https://health.ec.europa.eu/latest-updates/mpox-hera-donate-over-215000-vaccine-doses-africa-cdc-amid-urgent-outbreak-2024-08-14_en \u003c/li\u003e\n\u003cli\u003eFahima A, Tahira BH, Fahana A, Aurpy D, Shanta A, Sadia M, Abdullahi AM, Saif-Ur- Rahman KA (2023) Effect of prior immunization with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol 33(4): e24444. https://doi.org/10.1002/rmv.2444 \u003c/li\u003e\n\u003cli\u003eJahromi AS, Jokar M, Sharifi N, Kashkooli S, Rahmanian K, Rahmanian V (2024) Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis. Int Health 16(5):487-498. https://doi:10.1093/inthealth/ihad094 \u003c/li\u003e\n\u003cli\u003eJens E, Lennart CK, Henrike S (2023) How to reduce vaccination Hesitancy? The relevance of evidence and its communicator. Vaccine 41(27):3964-75. https://doi.org/10.1016/j.vaccine.2023.03.026 \u003c/li\u003e\n\u003cli\u003eJon C (2001) Smallpox vaccinations: How much protection remains?. Science 294(5544):985. https://doi.org/10.1126/science.294.5544.985 \u003c/li\u003e\n\u003cli\u003eKelly C, Andrea M, McCollum, Chistine MH, Benjamin M, Joelle K, Robert SL, Toutou L, Beatrice N, Elisabeth P (2023) Updating reproduction Number Estimates for Mpox in the Democratic Republic of Congo Using Surveillance Data. Am J Trop Med Hyg 110(3):561-68. https://doi.org/10.4269/ajtmh.23-0215. \u003c/li\u003e\n\u003cli\u003eKugelman JR, Johnston SC, Mulembakani PM, Kisalu N, Lee MS, Koroleva G, McCarthy SE, Gestole MC, Wolf ND, Fair JN (2014) Genomic variability of monkeypox virus among humans, Democratic Repulic of the Congo. Emerg Infect Dis 20 (2):232-9. https://doi:10.320/eid2002.130118. \u003c/li\u003e\n\u003cli\u003eLazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, Kimball S, El-Mohandes A (2021) A global survey of potential acceptance of a COVID-19 vaccine. Nat Med 27(2):225-228. https://doi:10.1038/s41591-020-1124-9. \u003c/li\u003e\n\u003cli\u003eLounis M, Hamimes A, Dahmani A (2024) Assessment of Monkeypox (MPOX) Knowledge and Vaccination Intention among Health and Life Sciences Students in Algeria: A Cross-Sectional Study. Infect Dis Rep 16(2):170-180. https://doi:10.3390/idr16020013. \u003c/li\u003e\n\u003cli\u003eLu J, Xing H, Wang C (2023) Mpox (formerly monkeypox): pathogenesis, prevention and treatment. Sig Transduct Target Ther 8, (458). https://doi.org/10.1038/s41392-023-01675-2 \u003c/li\u003e\n\u003cli\u003eMercy K, Tibebu B, Fallah M (2024) Mpox continues to spread in Africa and threatens global health security. Nat Med (30)1225\u0026ndash;1226. https://doi.org/10.1038/s41591-024-02862-6 \u003c/li\u003e\n\u003cli\u003eNicaise N, Ngashi N, Morenike OF, Jean MY, Fiona B, Salam AG, Moeti M, Jean K (2024) Africa\u0026apos;s mpox strategic preparedness and response plan: a coordinated continental effort to boost health security. The Lancet Global Health 0 (0). https://doi.org/10.1016/S2214-109x(24)00464-9. \u003c/li\u003e\n\u003cli\u003ePetrichko S, Kindrachuk J, Nkamba D, Halbrook M, Merritt S, Kalengi H, Kamba L, Beya M, Hoff NA, Luhata C, Kaba DK, Rimoin AW (2024) Mpox Vaccine Acceptance, Democratic Republic of the Congo. Emerg Infect Dis 30(12). https://doi:10.3201/eid3012.241226.\u003c/li\u003e\n\u003cli\u003ePiltch-Loeb R, Savoia E, Goldberg B, Hughes B, Verhey T, Kayyem J, Miller-Idriss C, Testa M (2021) Examining the effect of information channel on COVID-19 vaccine acceptance. PLoS One 16(5):e0251095. https://doi:10.1371/journal.pone.0251095. \u003c/li\u003e\n\u003cli\u003eRaosoft Inc (2004) Raosoft Sample Size Calculator. Available from: https://www.raosoft.com/samplesize.html \u003c/li\u003e\n\u003cli\u003eTanashat M, Altobaishat O, Sharaf A, Hossam El Din Moawad M, Al-Jafari M, Nashwan AJ (2024) Assessment of the knowledge, attitude, and perception of the world\u0026apos;s population towards monkeypox and its vaccines: A systematic review and descriptive analysis of cross-sectional studies. Vaccine X 20:100527. https://doi:10.1016/j.jvacx.2024.100527 \u003c/li\u003e\n\u003cli\u003eTeachers Service Commission (2023) Strategic Plan for 2023-2027 Available from: https://www.tsc.go.ke/index.php/downloads-b/file/1961-tsc-strategic-plan-2023-2027 \u003c/li\u003e\n\u003cli\u003eThe Nation Media (2024) Schools turn death traps due to lack of space and facilities. [Accessed on Aug 24]. https://nation.africa/kenya/news/education/schools-turn-death-traps-due-to-lack-of-space-and-facilities--4530646 \u003c/li\u003e\n\u003cli\u003eTuckerman J, Kaufman J, Danchin M (2022) Effective Approaches to Combat Vaccine Hesitancy. Pediatr Infect Dis J.41(5): e243-e245. https://doi:10.1097/INF.0000000000003499. \u003c/li\u003e\n\u003cli\u003eUNESCO (2020) The Kenya Ministry of Education\u0026rsquo;s response to the COVID-19 pandemic.https://unesdoc.unesco.org/ark:/48223/pf0000381092/PDF/381092eng.pdf.multi \u003c/li\u003e\n\u003cli\u003eUNICEF (2024) Kenya Mpox Level 3 Emergency. https://www.unicef.org/media/163471/file/Kenya-Humanitarian-Situation-Report-No.-1-(Level-3-Mpox),-03-October-2024.pdf \u003c/li\u003e\n\u003cli\u003eWHO (2023) Director-General\u0026rsquo;s opening remarks at the media briefing; [Accessed 2024 Aug 12]. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening -remark-at-the-media-briefing---11-may-2023 \u003c/li\u003e\n\u003cli\u003eWHO (2023) 2022-23 Mpox (Monkeypox) outbreak: global trends; [Accessed 2024 June 30]. https://worldhealthorg.shinyapps.io/mpx_global/. \u003c/li\u003e\n\u003cli\u003eWHO (2024) Mpox. https://www.who.int/news-room/fact-sheets/detail/mpox\u003c/li\u003e\n\u003cli\u003eWHO (2022) Multi-country outbreak of Mpox. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20221214_mpox_external-sitrep-12-.pdf \u003c/li\u003e\n\u003cli\u003eWHO (2015) Summary WHO SAGE conclusions and recommendations on Vaccine Hesitancy. https://www.who.int/docs/default-source/immunization/demand/summary-of-sage-vaccinehesitancy-en.pdf?sfvrsn=abbfd5c8_2\u003c/li\u003e\n\u003cli\u003eWHO (2015) Vaccine hesitancy: A growing challenge for immunization programmes. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes\u003c/li\u003e\n\u003cli\u003eWHO (2023) WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines. https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccines-SAGE-Prioritization-2023.1\u003c/li\u003e\n\u003cli\u003eWHO Africa Regional Office (2024) Interim public health advice for mpox-related prevention and control measures in school settings. https://www.afro.who.int/sites/default/files/202410/MpoxSchool_InterimPHA_27Sept2024.pdf\u003c/li\u003e\n\u003cli\u003eYang X, Hu C, Yang X, Yang X, Hu X, Wang X, Liu C, Yuan Y, Du S, Wang PG (2023) Evaluation and comparison of immune responses induced by two mpox mRNA vaccine candidates in mice. J Med Viorl 95(10): e29140. https://doi:10.1002/jmv.29140.\u003c/li\u003e\n\u003cli\u003eYang Y, Zhang W, Han B, Meng H, Wang J, Wu K, Fu L, Wang B, Jiang X, Li Q (2024) Mpox knowledge and vaccination hesitancy among healthcare workers in Beijing, China: A cross-sectional survey. Vaccine X 16:100434. https://doi:10.1016/j.jvacx.2024.100434. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Attitude, Mpox Knowledge, Mpox Vaccination, Hesitancy, Teachers","lastPublishedDoi":"10.21203/rs.3.rs-5511275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5511275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Sixteen African countries, including Kenya, reported mpox cases in July and August, prompting the Africa Centers for Disease Control to declare the outbreak a Public Health Emergency of Continental Security on 13\u003csup\u003eth\u003c/sup\u003e August 2024. The World Health Organization issued an advisory for mpox-related prevention in schools whereby teachers are expected to support mpox-infected students. There is a dearth of information of mpox knowledge and attitudes toward mpox vaccination among teachers in Kenya.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: An online survey involving 1139 teachers was conducted from 21\u003csup\u003est\u003c/sup\u003e August to 3\u003csup\u003erd\u003c/sup\u003e October, 2024 to determine the level of mpox knowledge and attitudes toward mpox vaccine and hesitancy factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The teachers’ mean mpox knowledge score was 8.2 out of 12 whereas the mean mpox attitude score was 3.7 out of 6. At the time of the survey, more than 34 % of the respondents were not aware of mpox cases in the country. The hesitancy rate for vaccination was 49.78 %. More than 62 % of participants cited concerns about vaccine side effects as the main reason for hesitancy. However, participants with certificate and diploma were more likely to accept to be vaccinated against mpox. Only 1.23 % of the participants received mpox information from the Teachers Service Commission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: \u0026nbsp;This study identifies gaps in mpox knowledge and attitudes toward mpox vaccination. It suggests that collaboration between the Teachers Service Commission and healthcare providers can ensure effective school community-based prevention strategies by improving mpox knowledge and attitudes toward mpox vaccination among teachers in Kenya.\u003c/p\u003e","manuscriptTitle":"Mpox knowledge, Attitudes towards Mpox vaccine and Hesitancy for Mpox vacciantion among Teachers in Kenya","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 09:04:57","doi":"10.21203/rs.3.rs-5511275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37d3cf7d-c347-4b46-bfe6-bd565f201e17","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-15T09:04:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 09:04:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5511275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5511275","identity":"rs-5511275","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}