Humayun Yousaf ¹ Abdul Qadeer ² Muhammad Sohail ^3* Muhammad Farooq ⁴ Zakir Khan ⁵ Dalia Fouad ^6* Yu-Chia Liu ^7* Chien-Chin Chen ⁷

• ¹ Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
• ² School of Life Science, Central South University, Changsha, China
• ³ School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, China, Yantai, China
• ⁴ University of Swabi, Swabi, Pakistan
• ⁵ International Islamic University, Islamabad, Islamabad, Islamabad, Pakistan
• ⁶ Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
• ⁷ Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

The re-emergence of monkeypox (MPX) in non-endemic countries has raised significant public health concerns. Public adherence to preventive measures is influenced by their understanding, attitudes, and perceptions of the monkeypox virus (MPXV). This study aimed to evaluate the knowledge, attitudes, and perceptions of MPXV in Pakistan. A cross-sectional survey was conducted from August 15 to August 30, 2022, with 3465 participants who completed a 37-question online survey covering sociodemographics, knowledge, attitudes, and perceptions of MPXV. Statistical analysis was performed using Python 3, with Pandas, Matplotlib, and stats libraries, and the chi-square test was used to examine associations. Among the participants, 79.51% were male, and 32.99% had postgraduate education. A significant correlation was found between education level and knowledge, with 99.24% of postgraduates exhibiting correct knowledge (p-value 0.0001). About 66.78% of participants correctly identified MPXV’s prevalence in African countries. Most (85.69%) knew that a virus causes MPXV, and 72.18% recognized it spreads via contaminated surfaces. Approximately 60.52% understood that antivirals are needed for treatment. Interestingly, 52.64% believed the chickenpox vaccine offers protection against MPXV. Regarding attitudes, 90.22% believed MPXV could be eradicated, and 86.7% felt that people should care more about each other. 81.36% considered visiting areas with MPXV outbreaks risky, and 83.95% would wear personal protective equipment when interacting with infected individuals. Additionally, 77.66% would perform hand hygiene after touching contaminated surfaces. Overall, participants showed strong knowledge and positive attitudes toward MPXV. However, these findings highlight the need for a comprehensive public health awareness strategy to prevent MPXV spread in Pakistan.