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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Int J Public Health</journal-id>
<journal-title>International Journal of Public Health</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Int J Public Health</abbrev-journal-title>
<issn pub-type="epub">1661-8564</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
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<article-id pub-id-type="publisher-id">1605149</article-id>
<article-id pub-id-type="doi">10.3389/ijph.2022.1605149</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Public Health Archive</subject>
<subj-group>
<subject>Commentary</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Monkeypox Outbreaks in 2022: Battling Another &#x201c;Pandemic&#x201d; of Misinformation</article-title>
<alt-title alt-title-type="left-running-head">Ennab et al.</alt-title>
<alt-title alt-title-type="right-running-head">Monkeypox Outbreaks in 2022</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Ennab</surname>
<given-names>Farah</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="fn" rid="fn1">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1872931/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nawaz</surname>
<given-names>Faisal A.</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="fn" rid="fn1">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1762255/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Narain</surname>
<given-names>Kapil</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nchasi</surname>
<given-names>Goodluck</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Essar</surname>
<given-names>Mohammad Yasir</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1415345/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Head</surname>
<given-names>Michael G.</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Singla</surname>
<given-names>Rajeev K.</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/53650/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Atanasov</surname>
<given-names>Atanas G.</given-names>
</name>
<xref ref-type="aff" rid="aff8">
<sup>8</sup>
</xref>
<xref ref-type="aff" rid="aff9">
<sup>9</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Shen</surname>
<given-names>Bairong</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/688078/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>College of Medicine</institution>, <institution>Mohammed Bin Rashid University of Medicine and Health Sciences</institution>, <addr-line>Dubai</addr-line>, <country>United Arab Emirates</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Nelson R. Mandela School of Medicine</institution>, <institution>University of KwaZulu-Natal</institution>, <addr-line>Durban</addr-line>, <country>South Africa</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Department of Medicine, Catholic University of Health and Allied Sciences</institution>, <addr-line>Mwanza</addr-line>, <country>Tanzania</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Kabul University of Medical Sciences</institution>, <addr-line>Kabul</addr-line>, <country>Afghanistan</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Clinical Informatics Research Unit</institution>, <institution>Faculty of Medicine</institution>, <institution>University of Southampton</institution>, <addr-line>Southampton</addr-line>, <country>United Kingdom</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>Institutes for Systems Genetics</institution>, <institution>Frontiers Science Center for Disease-Related Molecular Network</institution>, <institution>West China Hospital</institution>, <institution>Sichuan University</institution>, <addr-line>Chengdu</addr-line>, <country>China</country>
</aff>
<aff id="aff7">
<sup>7</sup>
<institution>iGlobal Research and Publishing Foundation</institution>, <addr-line>New Delhi</addr-line>, <country>India</country>
</aff>
<aff id="aff8">
<sup>8</sup>
<institution>Ludwig Boltzmann Institute for Digital Health and Patient Safety</institution>, <institution>Medical University of Vienna</institution>, <addr-line>Vienna</addr-line>, <country>Austria</country>
</aff>
<aff id="aff9">
<sup>9</sup>
<institution>Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences</institution>, <addr-line>Jastrzebiec</addr-line>, <country>Poland</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1002523/overview">Olaf Von Dem Knesebeck</ext-link>, University Medical Center Hamburg-Eppendorf, Germany</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Atanas G. Atanasov, <email>Atanas.Atanasov@dhps.lbg.ac.at</email>; Bairong Shen, <email>bairong.shen@scu.edu.cn</email>
</corresp>
<fn fn-type="equal" id="fn1">
<label>
<sup>&#x2020;</sup>
</label>
<p>These authors have contributed equally to this work and share first authorship</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>14</day>
<month>07</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>67</volume>
<elocation-id>1605149</elocation-id>
<history>
<date date-type="received">
<day>18</day>
<month>06</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>06</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Ennab, Nawaz, Narain, Nchasi, Essar, Head, Singla, Atanasov and Shen.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Ennab, Nawaz, Narain, Nchasi, Essar, Head, Singla, Atanasov and Shen</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<kwd-group>
<kwd>Monkeypox</kwd>
<kwd>pandemic</kwd>
<kwd>infodemic</kwd>
<kwd>outbreak</kwd>
<kwd>infection</kwd>
<kwd>infection control</kwd>
</kwd-group>
<contract-sponsor id="cn001">National Natural Science Foundation of China<named-content content-type="fundref-id">10.13039/501100001809</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">West China Hospital, Sichuan University<named-content content-type="fundref-id">10.13039/501100013365</named-content>
</contract-sponsor>
</article-meta>
</front>
<body>
<p>Monkeypox is a virus that was formerly recognized as a rare zoonotic disease but has been noted as an emerging disease of concern where there are significant gaps in knowledge. In 2022, Monkeypox outbreaks are being concurrently reported in numerous non-endemic geographical areas, thus instigating a global wave of public health concern amid calls for urgent action from international authorities. As of the 8th of June 2022, about 1,285 laboratory-confirmed cases were detected in 28 regions across Africa, the Americas, and the European Region [<xref ref-type="bibr" rid="B1">1</xref>]. This virus is more commonly reported in West and Central Africa, where previous self-limiting outbreaks have had a mortality rate ranging between 1% and 15% [<xref ref-type="bibr" rid="B2">2</xref>]. However, the alarming surge of cases in 2022 with obvious multi-country community transmission is raising the alarm bells for monkeypox as a potential future global threat with unprecedented ramifications [<xref ref-type="bibr" rid="B3">3</xref>].</p>
<p>Misinformation is plentiful as Monkeypox virus cases are on the rise. The sensational nature of misinformation results in it being easily distributed and false beliefs perpetuated, further compounding the situation and causing widespread &#x201c;misinfodemic&#x201d; [<xref ref-type="bibr" rid="B4">4</xref>]. Misinformation is commonly-observed with high-profile disease outbreaks. The high degree of misinformation witnessed during the COVID-19 pandemic prompted the World Health Organization (WHO) to host the 1st WHO Infodemiology Conference in 2020 with international experts from various social and political backgrounds in order to manage this public health threat and establish a community of practice and research [<xref ref-type="bibr" rid="B5">5</xref>].</p>
<p>The origin of the Monkeypox virus, both in terms of the &#x201c;first ever&#x201d; monkeypox cases and also the origins of this 2022 outbreak, is widely questioned on social media. Both plausible and unlikely scenarios are discussed by a range of public commentators. One false claim is that the virus was manufactured and released intentionally from a laboratory in China. Furthermore, there are clearly unsubstantiated myths linking the Monkeypox virus to COVID-19 vaccination, stemming from the idea that the AstraZeneca vaccine utilized a chimpanzee viral vector. Monkeypox is a pox virus whilst the AstraZeneca vaccine is based on a weakened and altered adenovirus vector that cannot infect humans [<xref ref-type="bibr" rid="B6">6</xref>]. In addition, various social media platforms have been riddled with false narratives; one example is there from many Facebook posts, claiming that the current rash images that are broadcasted in mainstream media are merely a production of edited and reused photos from previous outbreaks in African countries, suggesting that the current outbreaks in 2022 are a hoax [<xref ref-type="bibr" rid="B7">7</xref>]. Another claim that was widely shared on Twitter was the suggestion that the Monkeypox virus was intentionally rolled out by powerful entities in the private health sector in order to benefit the pharmaceutical companies that manufacture vaccines and medical therapies [<xref ref-type="bibr" rid="B2">2</xref>].</p>
<p>Misinformation can drive stigma [<xref ref-type="bibr" rid="B8">8</xref>]. Given that many of the cases reported so far are linked to sexual networks, the public health messaging has to strike a balance between highlighting the transmission within highest-risk populations, whilst also encouraging potential new cases to report to a health facility. Strategies that can mitigate any impact of the rising Monkeypox misinfodemic are warranted. This should involve multi-faceted initiatives across diverse global health stakeholders. Community engagement across social media is vital to combat this challenge. Online awareness campaigns on sharing reputable resources related to Monkeypox transmission, treatment, and vaccination can help create an accessible source of reliable information for the public. This effort also involves collaborations between public health entities and social media platforms in actively promoting reliable information on the disease outbreak. Public health leaders, as well as social influencers, can play a strategic role in advocating for Monkeypox awareness on social media. A similar approach is recommended to target mega-event platforms such as the FIFA World Cup 2022 as &#x201c;incubators&#x201d; for raising awareness about the importance of COVID-19 vaccinations [<xref ref-type="bibr" rid="B9">9</xref>].</p>
<p>However, encouraging the spread of accurate information on social media is not enough to completely counter any harm of misinformation. An ongoing review of social media is necessary to identify evolving trends, new rumors, and key sources of misinformation. Introducing a flagging system for self-reporting suspicious posts related to Monkeypox misinformation can help foster responsible behaviors within the online community. Additionally, research is warranted for understanding the impact of misinformation on disease outbreaks <italic>via</italic> social media analysis of user behavioral trends. This can aid in exploring major causes of misinformation as well as predict disease outbreaks as seen during the COVID-19 pandemic [<xref ref-type="bibr" rid="B10">10</xref>].</p>
<p>Outbreaks of emerging infections like Monkeypox will continue to occur, and the general public will continue to seek information from easily accessible internet resources. Online misinformation leads to unwarranted public concern and may exacerbate the outbreak of emerging infectious diseases due to improper public health guidance. Multi-faceted efforts are warranted between governments, social media platforms, and community leaders in combatting this public health crisis.</p>
</body>
<back>
<sec id="s1">
<title>Author Contributions</title>
<p>All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.</p>
</sec>
<sec id="s2">
<title>Funding</title>
<p>This work was supported by the National Natural Science Foundation of China (32070671), the COVID-19 research projects of West China Hospital Sichuan University (Grant no. HX-2019-nCoV-057) as well as the regional innovation cooperation between Sichuan and Guangxi Provinces (2020YFQ0019). A. Sureda was granted by Instituto de Salud Carlos III (CIBEROBN CB12/03/30038).</p>
</sec>
<sec sec-type="COI-statement" id="s3">
<title>Conflict of Interest</title>
<p>RS has an honorary-based association with the iGlobal Research and Publishing Foundation (iGRPF), New Delhi, India.</p>
<p>The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<ack>
<p>The authors would like to thank the National Natural Science Foundation of China, West China Hospital Sichuan University as well as the regional innovation cooperation between Sichuan and Guangxi Provinces for providing necessary funding.</p>
</ack>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1.</label>
<citation citation-type="book">
<collab>WHO</collab>. <source>Multi-country Monkeypox Outbreak in Non-endemic Countries</source>. <comment>[Internet]</comment> (<year>2022</year>). <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385">https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385</ext-link>
</comment> (<comment>Accessed May 21, 2022</comment>). </citation>
</ref>
<ref id="B2">
<label>2.</label>
<citation citation-type="book">
<collab>The Lancet Infectious Diseases</collab>. <source>Monkeypox: A Neglected Old Foe</source>. <comment>[Internet]</comment> (<year>2022</year>). <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00377-2/fulltext">https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00377-2/fulltext</ext-link>
</comment> (<comment>Accessed June 9, 2022</comment>). </citation>
</ref>
<ref id="B3">
<label>3.</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Otu</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Ebenso</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Walley</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Barcel&#xf3;</surname>
<given-names>JM</given-names>
</name>
<name>
<surname>Ochu</surname>
<given-names>CL</given-names>
</name>
</person-group>. <article-title>Global Human Monkeypox Outbreak: Atypical Presentation Demanding Urgent Public Health Action</article-title>. <source>Lancet Microbe</source> (<year>2022</year>). <pub-id pub-id-type="doi">10.1016/S2666-5247(22)00153-7</pub-id> </citation>
</ref>
<ref id="B4">
<label>4.</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brainard</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Hunter</surname>
<given-names>PR</given-names>
</name>
</person-group>. <article-title>Misinformation Making a Disease Outbreak Worse: Outcomes Compared for Influenza, Monkeypox, and Norovirus</article-title>. <source>Simulation</source> (<year>2020</year>) <volume>96</volume>:<fpage>365</fpage>. <pub-id pub-id-type="doi">10.1177/0037549719885021</pub-id> </citation>
</ref>
<ref id="B5">
<label>5.</label>
<citation citation-type="journal">
<collab>The Lancet Infectious Diseases</collab>. <article-title>The COVID-19 Infodemic</article-title>. <source>Lancet Infect Dis</source> (<year>2020</year>) <volume>20</volume>(<issue>8</issue>):<fpage>875</fpage>. <pub-id pub-id-type="doi">10.1016/s1473-3099(20)30565-x</pub-id> </citation>
</ref>
<ref id="B6">
<label>6.</label>
<citation citation-type="book">
<collab>BBC News</collab>. <source>Monkeypox Wasn&#x2019;t Created in a Lab-and Other Claims Debunked</source>. <comment>[Internet]</comment> (<year>2022</year>). <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://www.bbc.com/news/health-61580089">https://www.bbc.com/news/health-61580089</ext-link>
</comment> (<comment>Accessed May 29, 2022</comment>). </citation>
</ref>
<ref id="B7">
<label>7.</label>
<citation citation-type="book">
<collab>Health Feedback</collab>. <source>Monkeypox Outbreak Triggers Conspiracy Theories on Social media Claiming that it Was Planned or Incorrectly Linking it to COVID-19 Vaccines</source>. <comment>[Internet]</comment> (<year>2022</year>). <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://healthfeedback.org/claimreview/monkeypox-outbreak-conspiracy-theories-claiming-it-was-planned-linking-with-covid-19-vaccines/">https://healthfeedback.org/claimreview/monkeypox-outbreak-conspiracy-theories-claiming-it-was-planned-linking-with-covid-19-vaccines/</ext-link>
</comment> (<comment>Accessed May 13, 2022</comment>). </citation>
</ref>
<ref id="B8">
<label>8.</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Islam</surname>
<given-names>MS</given-names>
</name>
<name>
<surname>Sarkar</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Khan</surname>
<given-names>SH</given-names>
</name>
<name>
<surname>Mostofa Kamal</surname>
<given-names>A-H</given-names>
</name>
<name>
<surname>Hasan</surname>
<given-names>SMM</given-names>
</name>
<name>
<surname>Kabir</surname>
<given-names>A</given-names>
</name>
<etal/>
</person-group> <article-title>COVID-19-Related Infodemic and its Impact on Public Health: A Global Social Media Analysis</article-title>. <source>Am J Trop Med Hyg</source> (<year>2020</year>) <volume>103</volume>(<issue>4</issue>):<fpage>1621</fpage>&#x2013;<lpage>9</lpage>. <pub-id pub-id-type="doi">10.4269/ajtmh.20-0812</pub-id> </citation>
</ref>
<ref id="B9">
<label>9.</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Essar</surname>
<given-names>MY</given-names>
</name>
<name>
<surname>Nawaz</surname>
<given-names>FA</given-names>
</name>
<name>
<surname>Kacimi</surname>
<given-names>SEO</given-names>
</name>
<name>
<surname>Djedid</surname>
<given-names>SNK</given-names>
</name>
<name>
<surname>Shah</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Ghozy</surname>
<given-names>S</given-names>
</name>
<etal/>
</person-group> <article-title>Enhancing Public Trust in COVID-19 Vaccination during the 2022 FIFA Men&#x2019;s World Cup: A Call for Action</article-title>. <source>Br J Sports Med</source> (<year>2022</year>). <pub-id pub-id-type="doi">10.1136/bjsports-2021-105249</pub-id> </citation>
</ref>
<ref id="B10">
<label>10.</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yousefinaghani</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Dara</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Mubareka</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Sharif</surname>
<given-names>S</given-names>
</name>
</person-group>. <article-title>Prediction of COVID-19 Waves Using Social Media and Google Search: A Case Study of the US and Canada</article-title>. <source>Front Public Health</source> (<year>2021</year>) <volume>9</volume>:<fpage>656635</fpage>. <pub-id pub-id-type="doi">10.3389/fpubh.2021.656635</pub-id> </citation>
</ref>
</ref-list>
</back>
</article>