Evaluating monkeypox knowledge among Jordanian pharmacists and pharmacy students: bridging the knowledge gap

Evaluating monkeypox knowledge among Jordanian pharmacists and pharmacy students: bridging the knowledge gap Razan I. Nassar1, Alhareth Ahmad2, Leen Fino1, Muna Barakat1, Deena Fares3, Noor Nassar4, Ahmad A. Assiri5,6 , Dina Raed Abu-Alsamen7, Amin M. Omar8 1 Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan 2 Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan 3 Faculty of Pharmacy, Applied Science Private University, Amman, Jordan 4 Pharmaceutical Procurement, Department of Pharmacy, King Hussain Cancer Center, Amman, Jordan 5 School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, Belfast, UK 6 Department of Pharmacognosy, College of Pharmacy, Najran University, Najran, Saudi Arabia 7 Institute of Pancreatic Disease , Department of Gastroenterology, Semmelweis University, Üllői út 26, Budapest 1085, Hungary 8 Department of Pharmaceutical Science and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan Corresponding author: Razan I. Nassar ([email protected]) Received 7 October 2025♦ Accepted 24 November 2025♦ Published 5 December 2025 Citation: Nassar RI, Ahmad A, Fino L, Barakat M, Fares D, Nassar N, Assiri AA, Abu-Alsamen DR, Omar AM (2025) Evaluating monkeypox knowledge among Jordanian pharmacists and pharmacy students: bridging the knowledge gap. Pharmacia 72: 1–10. https://doi.org/10.3897/pharmacia.72.e174238 Abstract Background: The World Health Organization has declared monkeypox a global public health emergency. The involvement of healthcare providers, such as pharmacists, plays a crucial role in disease control. Methods: A cross-sectional survey was conducted to assess the knowledge of monkeypox among Jordanian pharmacists and pharmacy students, as well as their ability to diagnose and manage monkeypox cases. The survey was developed based on an extensive literature review, assessed for face and content validity, and pilot tested. It was divided into three sections addressing demographics, knowledge, and the ability to diagnose and manage monkeypox cases. Results: The mean age of the study participants (n = 586) was 24.94 years (SD = 6.93). The primary information source about monkeypox was published research. The total knowledge scores (TK-score) ranged from −5 to 17, with a median of 6 (IQR: 3.0–9.0), while the symptoms knowledge scores (SK-score) ranged from −5 to 9, with a median of 2 (IQR: 1.0–4.0). A significant difference in TKscore was observed between males and females (p-value = 0.003), with a median TK-score of 5.0 for males (IQR: 3.0–8.0) and 6.0 for females (IQR: 4.0–9.0). Most participants were not confident in their ability to diagnose (82.9%) or manage (79.9%) monkeypox cases. Conclusion: Study participants demonstrated moderate knowledge concerning monkeypox. However, some items revealed areas for improvement, such as understanding transmission modes and prevention strategies. The findings also revealed low confidence levels in diagnosing and managing monkeypox. The moderate knowledge, coupled with low confidence, highlights the need for educational intervention. Keywords Diagnose, Jordan, knowledge, management, monkeypox, pharmacists, pharmacy students Copyright Nassar RI et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pharmacia 72: 1–10 DOI 10.3897/pharmacia.72.e174238 Research Article Nassar RI et al.: Evaluating Monkeypox Knowledge Among Jordanian Pharmacists and Pharmacy Students2 Introduction As the world is still dealing with the long-term consequences of the COVID-19 pandemic (Al-Shudifat et al. 2025), the possibility of a new outbreak causes major concerns (Aljabali et al. 2022). Monkeypox has been declared a public health emergency of global concern by the World Health Organization (WHO) (WHO 2022a). The identification of the monkeypox virus dates back to 1958, when an outbreak among monkeys occurred in a Danish laboratory, leading to its discovery (Brown and Leggat 2016). The virus is characterized as an enveloped virus with a brick-shaped structure, distinct for its replication process in the cytoplasm rather than the nucleus. In terms of size, the virus measures approximately 200–250 nm (Parker et al. 2007). Until July 2025, more than 99,500 confirmed cases have been reported worldwide (CDC 2022). While the majority of individuals tend to recover fully, there are instances where people experience severe illness (WHO 2022b). The most common monkeypox symptoms recognized during the 2022 outbreak are fever, swollen lymph nodes, muscle aches, and headache, as well as the development of a rash that may persist for 2 to 3 weeks. However, the difference in virus severity is influenced by the host’s susceptibility to the virus, the route of transmission, and the inoculated virus quantity (Guarner et al. 2004). Monkeypox can be transmitted from person to person in various ways, including skin-to-skin (e.g., touching) and face-to-face interactions (e.g., talking and breathing). It can also be transmitted by contaminated surfaces or objects (Alsanafi et al. 2022, Sallam et al. 2022a, WHO 2022b). The involvement of healthcare providers, including pharmacists, is of utmost importance in controlling diseases (Mukattash et al. 2018, Alhamad et al. 2021, Abu Hammour et al. 2022, Zakaraya et al. 2025). Improving the ability of pharmacists to identify cases and provide appropriate patient management is one of the most vital aspects of the surveillance system (Harapan et al. 2020b). Pharmacists must possess sufficient knowledge to recognize clinical symptoms associated with monkeypox and effectively manage cases to prevent further transmission (Alsanafi et al. 2022). Accordingly, assessing pharmacists’ knowledge and ability to diagnose and manage monkeypox cases is essential, as this assessment can greatly contribute to developing effective control response plans. Considering the aforementioned points, the objective of the current study is to evaluate the knowledge of Jordanian pharmacists and pharmacy students regarding the monkeypox virus. Furthermore, the study aimed to assess their ability to diagnose and effectively manage monkeypox cases. Methods Study design and participants A descriptive cross-sectional study design was implemented to assess the knowledge level of Jordanian pharmacists and pharmacy students regarding monkeypox viral infection. The study utilized a web-based approach through Google Forms. Participation in the study was voluntary and did not pose any risk to the participants. Survey development The research team conducted a comprehensive literature review to develop the first draft of the survey. Several references were used to generate a pool of questions that aligned with the study objectives. The questions were then reviewed by the research team to combine concepts and remove irrelevant or unclear items. In order to ensure face and content validity, the initial draft of the survey was evaluated by four independent academics with previous experience in relevant research fields. They assessed the questions in terms of comprehension, relevancy, and word clarity. Then, they provided feedback and comments regarding any questions that were difficult to understand, irrelevant, or unclear. As a final step in the survey development, the research team revised the questions as necessary to make them brief and suitable for online administration. Consequently, a sample of 33 participants participated in the survey’s pilot, and their responses were not included in the final analysis. This pilot study assessed the survey’s comprehension, readability, and acceptability. Cronbach’s alpha was used to measure internal consistency and produced a coefficient of 0.77. The final version of the survey was organized into three main sections focusing on different topics of interest. In the first section, participants were requested to provide their demographic data, including gender, age, marital status, living place, and educational level. Pharmacy students were further asked about their university type (public or private university), their current academic year, and the number of workshops they attended per year. Pharmacists or graduates were asked about the nature of their work or occupation, the number of years of experience, and the number of workshops they attended annually. The second section inquired about the sources of information that participants relied upon to obtain information about monkeypox. This section also comprised 26 items designed to assess participants’ monkeypox knowledge. Some of the 26 items were incorrect items (false statements). For these incorrect items, a participant’s correct answer involved identifying the statement as false, while a wrong answer involved identifying it as true. The third section assessed participants’ ability to diagnose and manage monkeypox cases. Furthermore, it included items regarding participants’ future perception of monkeypox. Survey implementation Study participants were recruited primarily through social media platforms such as Facebook and WhatsApp or by sending e-mails. Those willing to consider participation were provided with a link that enabled them to initially view ethics Pharmacia 72: 1–10 3 committee–approved information about the study and then proceed to the survey. The research team designed the survey to be completed within a timeframe of 5 to 7 minutes. Sample size The sample size was calculated using a margin of error of 5%, a confidence level of 95%, and a response distribution of 50%. Based on these parameters, the minimum required sample size was 385 participants. Statistical analysis Following data collection, the survey responses were coded and entered into a customized database using the Statistical Package for the Social Sciences (SPSS), Version 27.0 (IBM Corp., Armonk, New York, USA). The knowledge gap between pharmacists and students was assessed using the Pearson chi-square test. The normality of the total knowledge score (TK-score) and symptoms knowledge score (SK-score) was assessed using the Shapiro–Wilk test. Accordingly, non-parametric tests were used for group comparisons, and data were reported as median and interquartile range (IQR). In addition, a Mann–Whitney U test was conducted to compare the monkeypox knowledge scores for different groups (males and females). Statistical significance was defined as a p-value of 0.05. The 26 items in the knowledge section had three possible responses: True, I do not know, and False. The “I do not know” answer received a score of 0, while a correct answer received a score of 1. A wrong response, on the other hand, received a score of −1. The participants’ total knowledge score (TK-score) ranged from −26 to 26, considering the cumulative scores from all 26 items. Additionally, a symptom knowledge score (SK-score) was extracted from the knowledge section, consisting of nine specific items. The SK score ranged from −9 to 9, considering the individual scores for those nine items. Results Demographic characteristics A total of 586 participants comprised the final sample size of the study. The mean age of the study participants was 24.94 (SD = 6.93) years. Almost three-quarters of the study participants were female (n = 436, 74.4%), and about 80.0% were single (n = 468). The majority were living in the capital, Amman (n = 448, 76.5%). Half of the participants had a bachelor’s degree (n = 294, 50.2%), while 36.2% of them were students (n = 212). The detailed demographic characteristics of the study participants are shown in Table 1. Among the students (n = 212), 74.5% were females (n = 158). The mean age of students was 21.41 (SD = 2.61) years. Three-quarters were studying in a private university (n = 154, 75.6%). Furthermore, most of them were in their fifth year (n = 64, 30.2%), followed by second-year (n = 63, 29.7%) and third-year students (n = 33, 15.5%). Regarding the number of workshops attended per year, 22.6% of the students did not attend any workshop (n = 48), while 51.0% attended one or two workshops (n = 108). On the other hand, 7.5% (n = 16) attended more than 5 workshops annually (Table 2). Table 1. Demographic characteristics of the study’s participants (n = 586). Parameter Students (n = 212) Pharmacists (n = 374) Total n (586) n (%) Gender Male 54 (25.5) 96 (25.6) 150 (25.6) Female 158 (74.5) 278 (74.3) 436 (74.4) Marital Status Single 206 (97.2) 262 (70.1) 468 (79.9) Married 6 (2.8) 102 (27.3) 105 (17.9) Divorced – 10 (2.7) 10 (1.7) Widowed – – 3 (0.5) Living place Amman (the Capital) 144 (67.9) 304 (81.3) 448 (76.5) Balqa’a 38 (17.9) 44 (11.8) 82 (14.0) Irbid 12 (5.7) 10 (2.7) 23 (3.9) Other 18 (8.5) 16 (4.2) 33 (5.6) Educational level I am a student 212 (100) – 212 (36.2) Diploma* – 24 (6.4) 23 (3.9) Bachelor’s degree – 294 (78.6) 294 (50.2) Postgraduate degree (Master’s or PhD) – 56 (15.0) 57 (9.7) *: A post–high school qualification completed within 2 to 3 years at community colleges. Nassar RI et al.: Evaluating Monkeypox Knowledge Among Jordanian Pharmacists and Pharmacy Students4 For the graduated pharmacists group (n = 374), 74.3% were females (n = 278). The mean age of the pharmacists was 26.94 (SD = 7.77) years. About one-quarter (n = 91, 24.3%) of them were academics, while 31.3% were community pharmacists (n = 117). Most graduates had 1 to 5 years of experience (n = 293). With regard to the number of workshops they attended annually, 21.9% of them did not attend any workshops (n = 82), whereas 41.7% attended one or two workshops (n = 156). However, 11.5% (n = 43) attended more than five workshops (Table 2). Table 2. Detailed demographic information regarding graduated pharmacists and pharmacy students. Students (n = 212) Graduated Pharmacists (n = 374) Parameter n (%) Parameter n (%) Type of University Employment Public 58 (27.4) Academic 91 (24.3) Private 154 (75.6) Community pharmacist 117 (31.3) An employee in a government department 4 (1.1) Employee in a private company 49 (13.1) Other 113 (30.2) Current year Experience years First-year 10 (4.7) 1–5 293 (78.3) Second-year 63 (29.7) 6–10 46 (12.3) Third-year 33 (15.5) 11–5 14 (3.7) Fourth-year 32 (15.1) 16–20 11 (2.9) Fifth-year 64 (30.2) 21–25 10 (2.7) Sixth year (PharmD) 10 (4.7) Number of attended workshops per year Number of attended workshops per year None 48 (22.6) None 82 (21.9) One workshop 30 (14.2) One workshop 83 (22.2) Two workshops 78 (36.8) Two workshops 73 (19.5) Three workshops 24 (11.3) Three workshops 62 (16.6) Four workshops 9 (4.2) Four workshops 17 (4.5) Five workshops 7 (3.3) Five workshops 14 (3.7) More than 5 workshops 16 (7.5) More than 5 workshops 43 (11.5) The most common source of information used by the participants to obtain information about monkeypox was published research (n = 450, 76.8%), followed by WHO reports (n = 434, 74.1%) and exposure to related courses or lectures within the pharmacy curriculum at the faculty of pharmacy (n = 358, 61.1%). Whereas, family and friends were reported the least (n = 276, 47.1%) as a source of information (Fig. 1). Knowledge section Assessing study participants’ (n = 586) knowledge regarding monkeypox using the 26 knowledge items (Fig. 2) revealed that item 3, “Fever is one of the monkeypox symptoms,” had the highest percentage of correct answers (n = 498, 85.0%), followed by item 2, “Monkeypox can spread from animals to humans” (n = 454, 77.5%), and item 13, “Development of a rash may last for two to three weeks” (n = 433, 73.9%). In contrast, the majority of the study participants answered item 21 incorrectly: “If you have had close contact with someone who has monkeypox, you should monitor yourself closely for signs and symptoms for 14 days after the time you were last exposed,” as only 5.1% (n = 30) answered it correctly. In addition, item 22, “If it is difficult to avoid being in the same room with someone who has monkeypox, maintain a distance of at least 3 meters from them,” was answered correctly by only 8.9% (n = 52) of the participants. As shown in Table 3, more pharmacists than students were aware of monkeypox symptoms, including fever (87.7% vs. 80.2%; p-value = 0.014), headache (73.3% vs. 63.2%; p-value = 0.011), and rash development (76.7% vs. 68.9%; p-value = 0.045), in addition to the incubation period (53.7% vs. 42.5%; p-value = 0.010). Likewise, more pharmacists than students identified that the following statements are incorrect: monkeypox is a bacterial zoonotic infection (62.0% vs. 43.8%; p-value < 0.001), diarrhea is one of the monkeypox symptoms (17.6% vs. 10.4%; p-value = 0.018), common household disinfectants are not enough to kill the monkeypox virus (19.5% vs. 12.3%; p-value = 0.029), if it is difficult to avoid being in the same room with someone who has monkeypox, maintain a distance of at least 3 meters from them (11.8% vs. 3.8%; p-value = 0.001), and antibiotics can be used to treat monkeypox (39.6% vs. 30.2%; p-value = 0.023). The participants’ total knowledge score (TK-score) was not normally distributed, and scores ranged from −5 to 17 (Fig. 3). The median TK-score was 6 (IQR: 3.0–9.0), on a scale from −26 (lowest) to 26 (highest). Moreover, on a scale from −9 to 9, the participants’ symptom knowledge scores (SK-score) ranged from −5 to 9, with a median of 2 (IQR: 1.0–4.0). A Mann–Whitney U test was conducted to compare the monkeypox total knowledge scores (TK-score) for males and females. There was a statistically significant difference (p-value = 0.003, U = 27,410.0, Z = −2.965), with a median TK-score of 5.0 for males (IQR: 3.0–8.0) and a median of 6.0 for females (IQR: 4.0–9.0). Pharmacia 72: 1–10 5 Table 3. Assessment of study participants’ (pharmacists and students) knowledge regarding monkeypox (n = 586). Statements The correct answer, n (%) p-value# Total Students Pharmacists n = 586 n = 212 n = 374 1. Monkeypox is a bacterial zoonotic infection 325 (55.5) 93 (43.8) 232 (62.0) <0.001 2. Monkeypox can spread from animals to humans 454 (77.5) 161 (75.9) 293 (78.3) 0.644 3. Fever is one of the monkeypox symptoms 498 (85.0) 170 (80.2) 328 (87.7) 0.014 4. Headache is one of the monkeypox symptoms 408 (69.6) 134 (63.2) 274 (73.3) 0.011 5. Muscle ache is one of the monkeypox symptoms 407 (69.5) 137 (64.6) 270 (72.2) 0.073 6. Back pain is one of the monkeypox symptoms 307 (52.4) 101 (47.6) 206 (55.1) 0.105 7. Swollen lymph nodes are some of the monkeypox symptoms 297 (50.7) 96 (45.3) 201 (53.7) 0.057 8. Diarrhea is one of the monkeypox symptoms 88 (14.8) 22 (10.4) 66 (17.6) 0.018 9. Lung infection is one of the monkeypox symptoms 129 (22.0) 51 (24.0) 78 (20.9) 0.442 10. Nasal congestion and sore throat are some of the monkeypox symptoms 151 (25.7) 49 (23.1) 102 (27.3) 0.328 11. Loss of taste or smell is one of the monkeypox symptoms 247 (42.2) 83 (39.2) 164 (43.9) 0.320 12. A person can be infected without showing any symptoms 190 (32.4) 61 (28.7) 129 (34.5) 0.172 13. Development of a rash may last for two to three weeks 433 (73.9) 146 (68.9) 287 (76.7) 0.045 14. The rash can affect the face, palms of the hands, and soles of the feet 395 (67.4) 134 (63.2) 261 (69.8) 0.089 15. The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days 291 (49.7) 90 (42.5) 201 (53.7) 0.010 16. The rash can affect the genital or anal regions 270 (46.1) 99 (47.6) 171 (45.7) 0.689 17. When an infectious person touches surfaces, someone else who touches these surfaces may become infected if they have any cuts or abrasions 366 (62.5) 125 (59.0) 241 (64.4) 0.135 18. Monkeypox can be transmitted through using personal fomite 420 (71.7) 142 (67.0) 278 (74.3) 0.058 19. Monkeypox can be transmitted during pregnancy to the fetus 202 (34.5) 63 (29.7) 139 (37.2) 0.101 20. Common household disinfectants are not enough to kill the monkeypox 99 (16.9) 26 (12.3) 73 (19.5) 0.029 21. If you have had close contact with someone who has monkeypox, you should monitor yourself closely for signs and symptoms for 14 days after the time you were last exposed 30 (5.1) 6 (2.8) 24 (6.4) 0.058 22. If it is difficult to avoid being in the same room with someone who has monkeypox, maintain a distance of at least 3 meters from them 52 (8.9) 8 (3.8) 44 (11.8) 0.001 23. There is a vaccine against monkeypox 163 (27.8) 67 (31.6) 96 (25.7) 0.097 24. Children may be at greater risk of severe monkeypox than adults 245 (41.8) 92 (43.4) 153 (40.9) 0.516 25. Past exposure to chickenpox does provide protection against monkeypox 150 (25.6) 48 (22.6) 102 (27.3) 0.217 26. Antibiotics can be used to treat monkeypox 212 (36.2) 64 (30.2) 148 (39.6) 0.023 # Using the chi-square test, *Significant at the 0.05 significance level. Figure 1. The sources of information on monkeypox used by the study participants (n = 586). Nassar RI et al.: Evaluating Monkeypox Knowledge Among Jordanian Pharmacists and Pharmacy Students6 Confidence to diagnose and manage monkeypox The majority of the study participants (n = 586) were not confident in their ability to diagnose (n = 486, 82.9%) nor manage (n = 468, 79.9%) monkeypox cases (Fig. 4). Perception of monkeypox Assessing participants’ perceptions revealed that almost half of the study participants (n = 302, 51.5%) believed that having COVID-19 or long COVID-19 increases the risk of contracting or experiencing serious symptoms from monkeypox (Fig. 5). In addition, only 15.0% (n = 88) of the participants reported that individuals who received the COVID-19 vaccine are at high risk of contracting or experiencing serious symptoms from monkeypox. In addition, according to nearly half of the study participants, monkeypox is the potential next epidemic after COVID-19 (n = 296, 50.5%). Discussion The current study is the first investigation to be conducted in Jordan regarding the assessment of monkeypox knowledge among both Jordanian pharmacists and pharmacy students. It also assesses their ability to diagnose and manage monkeypox cases. The study findings revealed that both pharmacists and pharmacy students in Jordan were aware of the monkeypox virus symptoms, including fever, headache, and the development of a rash. However, the study’s participants exhibited limited knowledge about the virus’s transmission and prevention. These findings align with similar observations reported among healthcare providers and students worldwide (Alsanafi et al. 2022, Alshahrani et al. 2022, Riccò et al. 2022, Sallam et al. 2022b, Abu-Farha et al. 2023, Youssef et al. 2023, Nassar et al. 2024). Low levels of monkeypox knowledge were reported among healthcare professionals, including physicians, in Italy (Riccò et al. 2022); physicians and nurses in Jordan (Sallam et al. 2022b); and health professionals in Kuwait (Alsanafi et al. 2022). This was also observed among the general public in Saudi Arabia (Alshahrani et al. 2022) and Lebanon (Youssef et al. 2023). In the present study, moderate levels of monkeypox knowledge can be rationalized by the young mean age of the study sample (24.9 years), with a majority being early-career pharmacists or pharmacy students. The identified knowledge gaps reveal a vital need for incorporating monkeypox education and training in pharmacy undergraduate curricula and professional development courses. Furthermore, the literature emphasizes that education and training are achieved by offering education and training to improve the quality of care among healthcare providers, which is a fundamental goal in providing safe and high-quality patient service (The World Health Organization 2005, Sallam et al. 2022b). Figure 2. Study participants’ (n = 586) responses to the 26 knowledge items. Pharmacia 72: 1–10 7 Figure 3. Study participants’ (n = 586) knowledge scores. Figure 4. Assessment of study participants’ (n = 586) confidence to diagnose and manage monkeypox cases. Nassar RI et al.: Evaluating Monkeypox Knowledge Among Jordanian Pharmacists and Pharmacy Students8 It is also worth mentioning that the monkeypox diagnosis and management confidence levels were generally found to be low among the participants of this study. The vast majority of the participating pharmacists and pharmacy students had low confidence levels in their ability to diagnose (82.9%) and manage (79.9%) monkeypox cases. Similarly, literature reported that Jordanian physicians’ and nurses’ confidence levels were also deemed low regarding the diagnosis and management of monkeypox (Sallam et al. 2022b). This is not unique to the Jordanian healthcare providers’ context, as other countries such as Italy and Indonesia have reported similar findings. This was attributed to the relatively young age of the study sample, which intrinsically comes with a subsequent lower level of confidence in medical practice (Harapan et al. 2020a). It also suggests that being exposed to such knowledge during undergraduate education and continuous education via attending conferences, for instance, boosts confidence levels and is reflected in an enhanced response to the current monkeypox outbreak (The World Health Organization 2005, Harapan et al. 2020a). The current study revealed an interesting perspective, with nearly half of the participants agreeing that exposure to COVID-19 might increase the risk of contracting or even developing serious monkeypox symptoms. Moreover, they also believed that the monkeypox virus holds the potential to be considered the next epidemic after COVID-19. It is worth highlighting that the general population who previously developed COVID-19 in Saudi Arabia worried more about the monkeypox disease than others who were not infected before (Temsah et al. 2022). This study has several limitations. One of them is associated with the sampling approach, particularly self-selection bias. This bias occurs when a specific group of individuals participates in the survey while others do not. For instance, only individuals with internet access can participate. Another limitation is that relying on a self-administered survey could result in over-reporting or under-reporting errors, impacting the accuracy of the results to some extent. Furthermore, the detailed breakdown of the “Other” employment category in the demographic section was not collected, which limited the ability to classify the participants accurately. In addition, the sample size of the current study was calculated based on estimating proportions for the overall population rather than detecting differences between two independent groups (pharmacists and students). Although the final sample exceeded the minimum calculated number, with 586 participants in total, the sample size should have been calculated separately for the two groups to capture possible differences and allow a more comprehensive comparison between pharmacists and students. Conclusion The study’s participants had a moderate understanding of monkeypox. Areas for improvement were revealed among the study’s participants, such as knowledge of preventative techniques and modes of transmission. A statistically significant difference was found in scores between different genders. The findings demonstrated that participants had low confidence in their ability to identify and treat monkeypox. To increase the preparedness of pharmacists and pharmacy students to address these health challenges, educational interventions are required. Additional information Conflict of interest The authors declare no relevant conflicts of interest or financial relationships. Ethical statements Ethical approval for this study was obtained from the Institutional Review Board Committee at the Faculty of Pharmacy, Applied Science Private University (Approval Number: 2022-PHA-32). The authors declared that no clinical trials were used in the present study. The authors declared that no experiments on humans or human tissues were performed for the present study. The authors declared that informed consent of the participants was obtained prior to study inclusion. The authors declared that no experiments on animals were performed for the present study. The authors declared that no commercially available immortalised human and animal cell lines were used in the present study. Use of AI No use of AI was reported. Figure 5. Study participants’ (n = 586) responses to the perception items. Pharmacia 72: 1–10 9 Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author contributions Conceptualization: RIN, AA, AMO. Data Curation: RIN, DF, DRA. Formal Analysis: RIN, AA, AMO. Investigation: RIN, AA, LF, MB, NN, AAA. Methodology: RIN, AA, LF, MB, MM, AAA. Validation: RIN, DF. Visualization: RIN, AMO. Writing – Original Draft Preparation: RIN, AA, LF, MB, DF, NN, AAA, DRA, AMO. Writing – Review & Editing: RIN, AA, LF, MB, DF, NN, AAA, DRA, AMO. All authors were involved in all parts of the study and manuscript preparation, including literature search, study design, analysis of data, manuscript preparation, and review of the manuscript. Author ORCIDs Razan I. Nassar https://orcid.org/0000-0001-8952-0376 Alhareth Ahmad https://orcid.org/0009-0006-0395-7491 Leen Fino https://orcid.org/0000-0002-5768-4912 Muna Barakat https://orcid.org/0000-0002-7966-1172 Deena Fares https://orcid.org/0009-0008-1602-5647 Noor Nassar https://orcid.org/0000-0002-6089-6131 Ahmad A. Assiri https://orcid.org/0009-0006-1081-1394 Dina Raed Abu-Alsamen https://orcid.org/0009-0006-69176524 Amin M. Omar https://orcid.org/0000-0003-2088-8628 Data availability The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. References Abu Hammour K, Abu Farha R, Ya’acoub R, Salman Z, Basheti I (2022) Impact of pharmacist-directed medication reconciliation in reducing medication discrepancies: A randomized controlled trial. Canadian Journal of Hospital Pharmacy 75: 169–177. https://doi.org/10.4212/ cjhp.3143 Abu-Farha RK, Alzoubi KH, Mukattash TL, Alkhawaldeh R, Barakat M, Thiab S (2023) Public knowledge and perceptions about the emerging human mpox in Jordan: A cross-sectional study. Tropical Medicine and Infectious Disease 8: 41. https://doi.org/10.3390/tropicalmed8010041 Alhamad H, Abu‐Farha R, Albahar F, Jaber D (2021) Public perceptions about pharmacists’ role in prescribing, providing education and delivering medications during COVID‐19 pandemic era. International Journal of Clinical Practice 75. https://doi.org/10.1111/ ijcp.13890 Aljabali AA, Obeid MA, Nusair MB, Hmedat A, Tambuwala MM (2022) Monkeypox virus: An emerging epidemic. Microbial Pathogenesis 173: 105794. Alsanafi M, Al-Mahzoum K, Sallam M (2022) Monkeypox knowledge and confidence in diagnosis and management with evaluation of emerging virus infection conspiracies among health professionals in Kuwait. Pathogens 11: 994. https://doi.org/10.1016/j.micpath.2022.105794 Alshahrani NZ, Alzahrani F, Alarifi AM, Algethami MR, Alhumam MN, Ayied HAM, Awan AZ, Almutairi AF, Bamakhrama SA, Almushari BS, Sah R (2022) Assessment of knowledge of monkeypox viral infection among the general population in Saudi Arabia. Pathogens 11: 904. https://doi.org/10.3390/pathogens11080904 Al-Shudifat AE, Al-Tamimi M, Alkhateeb M, Dawoud R, Alahmad A, Mryyian A, Al-Ramahi B, Qqish A, Abbas M (2025) Shortterm and long-term adverse effects of COVID-19 vaccines and its associated factors: A cross-sectional study from Jordan. Jordan Journal of Biological Sciences 18: 197–209. https://doi.org/10.54319/ jjbs/180201 Brown K, Leggat PA (2016) Human monkeypox: Current state of knowledge and implications for the future. Tropical Medicine and Infectious Disease 1: 1–13. https://doi.org/10.3390/tropicalmed1010008 CDC (2022) 2022 Monkeypox Outbreak Global Map. https://www.cdc. gov/poxvirus/monkeypox/response/2022/world-map.html Guarner J, Johnson BJ, Paddock CD, Shieh WJ, Goldsmith CS, Reynolds MG, Damon IK, Regnery RL, Zaki SR, Greer P, Packard MM, Lee W, Olson V, Kline R, Li Y, Stempora L (2004) Monkeypox transmission and pathogenesis in prairie dogs. Emerging Infectious Diseases 10: 426–431. https://doi.org/10.3201/eid1003.030878 Harapan H, Setiawan AM, Yufika A, Anwar S, Wahyuni S (2020a) Confidence in managing human monkeypox cases in Asia: A cross-sectional survey among general practitioners in Indonesia. Acta Tropica. https://doi.org/10.1016/j.actatropica.2020.105450 Harapan H, Setiawan AM, Yufika A, Anwar S, Wahyuni S, Asrizal FW, Sufri MR, Putra RP, Wijayanti NP, Salwiyadi S, Maulana R, Khusna A, Nusrina I, Shidiq M, Fitriani D, Muharrir M, Husna CA, Yusri F, Maulana R, Andalas M, Wagner AL, Mudatsir M (2020b) Knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in Indonesia. Pathogens and Global Health 114: 68–75. https://doi.org/10.1080/20477724.2020.1743037 Mukattash TL, Bazzi NH, Nuseir KQ, Jarab AS, Abu-Farha RK, Khdour MR (2018) Pharmaceutical care in community pharmacies in Jordan: a public survey. Pharmacy Practice 16: 1126. https://doi. org/10.18549/PharmPract.2018.02.1126 Nassar RI, Ahmad A, Basheti IA, Omar AM, Barqawi HJ, Alzoubi KH, Shahwan M, Al Moukdad AM, Al Moukdad MA, Abu-Gharbieh E (2024) Knowledge gap or prepared force? Exploring United Arab Emirates Pharmacy students and pharmacists’ monkeypox readiness. Healthcare 12: 2295. https://doi.org/10.3390/healthcare12222295 Parker S, Nuara A, Buller RML, Schultz DA (2007) Human monkeypox: An emerging zoonotic disease. Future Microbiology 2: 17–34. https://doi.org/10.2217/17460913.2.1.17 Riccò M, Ferraro P, Camisa V, Satta E, Zaniboni A, Ranzieri S, Baldassarre A, Zaffina S, Marchesi F (2022) When a neglected tropical disease goes global: Knowledge, attitudes and practices of Italian physicians towards monkeypox, preliminary results. Tropical Medicine and Infectious Disease 7. https://doi.org/10.3390/tropicalmed7070135 Sallam M, Eid H, Awamleh N, Al-Tammemi AB, Barakat M, Athamneh RY, Hallit S, Harapan H, Mahafzah A (2022a) Conspiratorial attitude