Proportions of moral distress.

In May 2022, the most widespread outbreak of sustained transmission of mpox outside of countries historically affected countries in Western and Central Africa occurred. We aimed to examine the personal and clinical experiences of international healthcare workers (HCWs) during this public health emergency. We conducted an international cross-sectional survey study between August and October 2022, examining the experiences and perceptions of HCWs clinically involved in the 2022 mpox response. Respondents were recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness; training and support at work; psychological well-being and vaccination. 725 multi-national healthcare workers across 41 countries were included in the analysis. 91% were physicians specialised in Sexual Health or Infectious Diseases; with 34% (n = 247) of all respondents involved in mpox policy. A substantial proportion of respondents (n = 296, 41%) reported working longer hours during the mpox outbreak, with no concomitant removal of other clinical responsibilities. 30% (n = 218) of respondents reported that they had never heard of mpox before the outbreak and over 25% of the respondents reported that they had misdiagnosed someone initially. This culminated in a high prevalence of moral distress at thirty percent. Less than 9% of HCWs in the region of the Caribbean, Central America and South America had been offered a vaccine as compared to almost one-third in the other regions. Where offered, there were high levels of uptake across all regions. The findings highlight a critical need for addressing the profound gaps in HCW knowledge about re-emerging diseases with pandemic potential. Strengthening the resilience of global health systems and prioritising internationally coordinated approaches to global vaccine deployment is imperative.

2022年5月，猴痘（mpox）在西非、中非既往受影响国家之外的区域，暴发了最为广泛的持续传播疫情。本研究旨在探究此次公共卫生紧急事件期间，国际医疗工作者（healthcare workers, HCWs）的个人与临床从业经历。我们于2022年8月至10月间开展了一项国际横断面调查研究，针对参与2022年猴痘（mpox）应对工作的临床医疗工作者的经历与认知展开调研。研究对象通过参与猴痘应对的性健康与HIV临床医师国际网络招募，并通过临床协会及社交媒体进行推广。调查维度涵盖临床工作量、应对准备情况、在职培训与支持、心理健康状况以及疫苗接种情况。最终共有来自41个国家的725名跨国医疗工作者纳入分析。其中91%为性健康或传染病专科医师；34%的受访者（n = 247）参与了猴痘相关政策制定。相当比例的受访者（n = 296，占比41%）表示，在猴痘暴发期间工作时长有所增加，且未被豁免其他临床工作职责。30%的受访者（n = 218）表示，在此次疫情暴发前从未听闻过猴痘；超过25%的受访者表示曾在诊疗初期出现过误诊情况。这一现状最终导致30%的受访者出现了较高程度的道德困扰（moral distress）。加勒比、中美洲及南美洲地区的医疗工作者中，仅有不足9%获得了疫苗接种机会，而其他地区这一比例接近三分之一。在获得疫苗接种机会的人群中，各区域的疫苗接种率均处于较高水平。本研究结果凸显出，针对具备大流行潜力的再发传染病，医疗工作者的知识储备存在显著缺口，亟需予以填补。强化全球卫生系统韧性，并优先采用国际协调的全球疫苗部署方案，已是势在必行。