YouTube and 2022 Monkeypox outbreak: opportunities for awareness and infection control.

A global outbreak of human monkeypox (MPX) is concerning. Cases have been reported in more than 40 countries, sparking widespread interest, and resulting in a possible increase in Internet searches, including video-sharing websites such as YouTube, a popular platform for streaming, saving, and uploading video content. YouTube is one of the most popular sources because it is free and easy to access and provides essential opportunities for medical information dissemination. However, the lack of regulation over incorrect or misleading content creates significant challenges. Previously, the use of YouTube as a source of information has been investigated for other epidemics.[3], [4], [5] Therefore, we analyzed the quality of available information about monkeypox from the most widely viewed YouTube videos.

On May 26, 2022, a search was conducted on the YouTube website (www.youtube.com) using the term 'monkeypox'. The 100 most viewed videos were reviewed and analyzed using the default' view count' filter. Exclusion criteria included non-English videos, duplicate videos, and videos with absent audio. Two independent reviewers classified videos as 'useful', 'misleading', or 'neither', crossing-match the publications and guidelines from the CDC and the World Health Organization (WHO). The sources were classified as healthcare/public health individuals, academic/health institutions, talk shows, news agencies, or independent users. The content was categorized into six overlapping categories: epidemiology, forms of transmission, symptoms, diagnostic testing, treatment, and prognosis. An analysis of associations among the three independent variables ('misleading' videos, 'useful' videos, and 'neither' videos) was performed, and continuous and categorical variables were compared using the student t-test and Chi-square test, respectively. The statistical analysis was performed using the STATA v.14.0 software (StataCorp LP, College Station, TX).

The videos have been watched a total of 23,000,533 times, and the number of views per video ranged between 69,556 and 1,794,685. Among the 100 videos, non-English-language videos (n = 31) and duplicates (n = 2) were excluded. A total of 67 videos were included in the study. Of these 67 included videos, 46 (68.6%) videos were classified as useful, 12 (17.9%) videos were classified as misleading, and 8 (11.9%) videos were classified as neither useful nor misleading.

Most videos were posted by news channels (n =28, 41.7%), followed by independent users (n =14, 20.8%), talk shows (n =11, 16.4%), healthcare/public health individuals (n =11, 16.4%), while only two (2.9%) of these were from academic/health institutions. Videos uploaded by healthcare/public health individuals were all classified as useful. Excluding the 'neither' videos, independent users were more likely to post misleading videos than useful videos (66.6% vs 10.8%, p< 0.001) (Table 1 ). Misleading videos had a higher number of likes when compared to useful videos (p = 0.012) and the majority presented messages of conspiracy theories about the fake outbreak created by international companies to sell vaccines and that monkeypox is a disease only transmitted through sexual intercourse and it is exclusive to LGTBI people and men who have sex with men.

Table 1

Comparison of the characteristics of the monkeypox videos on YouTube is classified as useful and misleading.

Variable	Useful (n = 46)	Misleading (n = 12)	p value
Number of views, median (IQR)	142,690 (98,311-192,977)	121,402 (89,108-209,078)	0.686
Number of likes, median (IQR)	4,400 (1,900-9,100)	8,950 (6,950-18,000)	0.012
Number of days on YouTube, median (IQR)	5 (3-6)	4 (2-6)	0.144
Source
Healthcare/public health individuals, n (%)	11 (23.91%)	0 (0%)	0.097
Academic/health institutions, n (%)	2 (4.35%)	0 (0%)	1
Talk shows, n (%)	6 (13.04%)	3 (25%)	0.374
News agencies, n (%)	22 (47.83%)	1 (8.33%)	0.019
Independent users, n (%)	5 (10.87%)	8 (66.67%)	<0.001
Content area
Epidemiology, n (%)	40 (86.96%)	1 (8.33%)	<0.001
Forms of transmission, n (%)	32 (69.57%)	11 (91.67%)	0.156
Symptoms, n (%)	37 (80.43%)	2 (16.67%)	<0.001
Diagnostic testing, n (%)	5 (10.87%)	0 (0%)	0.573
Treatment, n (%)	8 (17.39%)	0 (0%)	0.185
Prognosis, n (%)	20 (43.48%)	4 (33.33%)	0.744

Previous studies have shown the association between general knowledge of infectious diseases and infection control, although MPX is not a new disease in the world, cases are occurring in non-endemic countries, and healthcare workers also often use social media as a source of information, YouTube is a platform with significant potential in infection control, especially in raising awareness of forms of transmission and prevention methods in the community and the hospital environment.

Although the misinformation was only 11.9% of included videos, the risk of spread of misleading content is latent on YouTube; therefore, it should be implemented a medical misinformation policy in the early stages of the outbreak, as regulated in May 2020 for COVID-19, with which YouTube removed the content that contradicted WHO or local health authorities' medical information.

YouTube is an increasingly crucial source of medical information during the 2022 monkeypox outbreak and generally is a valuable source of information about monkeypox. However, the platform's open nature could quickly spread misleading content, especially those uploaded by independent users. Monitoring of YouTube content by healthcare institutions and experts could help infection control and reduce the spread of potentially harmful information in the event of further global disease outbreaks, as occurs with monkeypox.

Declaration of Competing Interest

The authors declare no potential conflict of interest with respect to the authorship and/or publication of this article.