Determinants of Mpox vaccine uptake and hesitancy among healthcare workers in Port Harcourt, Nigeria

Abstract

Mpox is a re-emerging zoonotic disease of global public health concern. Healthcare workers (HCWs) face elevated occupational risk and influence community vaccination behaviour, yet evidence on mpox vaccine uptake and hesitancy among Nigerian HCWs is limited. This study investigated the determinants of mpox vaccine uptake and hesitancy among HCWs in Port Harcourt, Nigeria. This cross-sectional study involved 595 HCWs recruited using multistage sampling across healthcare facilities in Port Harcourt between March and July 2025. Data collection employed a structured, validated, self-administered questionnaire encompassing sociodemographic and vaccine-related variables. Statistical analysis involved descriptive statistics, chi-square/Fisher’s exact tests, and multivariable logistic regression analyses using GraphPad Prism 9, with statistical significance set at p ≤ 0.05. Good mpox knowledge was recorded in 58.2% of respondents, while 97.8% expressed positive attitudes towards mpox and its vaccination. Nevertheless, mpox vaccine uptake was low (8.7%), though most vaccinated HCWs were fully vaccinated (86.5%). Hesitancy was 40.8%, and 62.2% were willing to recommend vaccination. In multivariable analyses, uptake was higher among HCWs in tertiary facilities (aOR = 5.32; 95% CI: 2.42–12.90; p < 0.0001), those with formal mpox training (aOR = 2.89; 95% CI: 1.52–5.47; p = 0.0011), those who had cared for suspected/confirmed mpox patients (aOR = 2.87; 95% CI: 1.40–5.79; p = 0.0035), and HCWs vaccinated against COVID-19 (aOR = 5.23; 95% CI: 2.56–11.60; p < 0.0001). Hesitancy increased with age (aOR = 1.05; 95% CI: 1.02–1.08; p = 0.0035) but was lower among COVID-19–vaccinated HCWs (aOR = 0.46; 95% CI: 0.31–0.67; p < 0.0001) and those with good mpox knowledge (aOR = 0.50; 95% CI: 0.28–0.89; p = 0.0193). The leading barriers were safety concerns (63.7%), insufficient information (56.8%), and access constraints (43.2%). Key motivators were assurance of safety/effectiveness (70.1%), convenient access (61.2%), and official recommendations (44.0%). A marked knowledge–attitude–behaviour gap persists. Expanding mpox training, improving risk communication, and delivering on-site vaccination beyond tertiary centres are essential to raise uptake, curb hesitancy, and strengthen Nigerian outbreak preparedness. Not applicable.