Until May 2022, hMPV was considered a neglected infectious disease. The continued growth of hMPV places an undue burden on HCPs [14]. WHO declared hMPV a major public health emergency due to its rapid spread among non-endemic countries [15].

Being an international concern, a collaborative response of all HCPs and the government is necessary for early screening, detection, applying preventive measures, and managing cases. However, among the challenges faced in this outbreak is the lack of knowledge about hMPV [16].

During the COVID-19 crisis, Pharmacists were described as key players and one of the most crucial HCPs providing medical care and awareness. Previous studies that described medical practices in Egypt placed community pharmacists as the closest HCPs to the public [11, 12].

With the current challenging situation, we need pharmacists and GPs to collaborate to identify suspected cases rapidly, promote public awareness, and manage patients [8]. Aside from strengthening governmental surveillance tools, creating an effective response to this outbreak necessitates increasing HCP's Knowledge and confidence [16]. Therefore, the current study aimed to assess the Knowledge of pharmacists and GPs (frontline HCPs) and strengthen their awareness of hMPV disease.

According to the CDC, in October 2022, 254 cases were discovered in Israel, 17 in Sudan, 1 in Jordan, 8 in KSA, and 11 in Lebanon [3]. The previous countries shared boundaries with Egypt. As a re-emerging disease, hMPV is uncommon in the Middle Eastern region. Moreover, nearly 40% of all groups did not hear about positive cases in Egypt or nearby countries.

Across the study, the participants presented an acceptable, accurate, and similar knowledge of hMPV. The current data indicates that merely 50% of each study group could answer the questionnaire items successfully. Clinical and community pharmacists presented similar knowledge to that of the GPs. This level of knowledge is acceptable as it is unusual for our participants to encounter such cases; however, dealing with cases is crucial for enhancing HCP knowledge [17].

Evaluating the knowledge of pharmacists and physicians would help to set measures to manage, prevent, and control the hMPV outbreak. It is vital to highlight the role of pharmacists and GPs’ Knowledge in educating the public and minimizing misinformation accompanied by infectious disease outbreaks [9, 18].

During the past COVID-19 pandemic, the viral spread of wrong information, especially through social media, amplified conspiratorial ideas and negatively impacted social, psychological, and health-related aspects [19, 20]. The demonstrated high Knowledge would be translated into providing corrective information and promoting a rapid and vigilant response.

The past results encouraged the authors to provide valid answers with references after completing the survey to raise pharmacists' and GPs' Knowledge about the current outbreak.

The current results are satisfactory, considering previous studies reporting low Knowledge among GPs and other HCPs [8, 14]. Also, previous studies reported significant knowledge gaps between HCPs [7, 8, 14]. As anticipated, studies on HCPs showed higher knowledge levels than the general population and university students [9, 16]. All studies on HCPs focused on estimating the knowledge of physicians, nurses, or allied health professionals. This study is the first to focus on the knowledge of hMPV among the community and clinical pharmacists.

Previous studies on HCP highlighted the presence of significant variations in knowledge about hMPV among HCPs, favouring physicians over allied health professionals (P < 0.03). However, nurses were more confident in diagnosing and managing this disease [7]. Also, a study in Jordan agreed that physicians showed a higher knowledge level of hMPV [9]. The current results indicated insignificant differences in the knowledge scores between pharmacists and GPs. However, clinical pharmacists reported higher mean knowledge scores than community pharmacists and GPs.

After five to 21 days of viral exposure, symptoms begin to appear [21]. Clinical pharmacists outperformed community pharmacists and GPs in providing the correct answers about the right incubation period.

The clinical picture of hMPV has been inconsistent in confirmed cases in the current outbreak [22]. Many patients are not experiencing the common symptoms of hMPV, including oral/vaginal/peri-anal lesions, fever, lymphadenopathy, cutaneous symptoms, and swallowing difficulties [23].

This disease shares a similar clinical picture with smallpox, with mild symptoms and a better prognosis [24]. The transmission of hMPV occurs via direct contact with infected animals, humans, and body fluids. Face-to-face transmission is very likely, but airborne transmission has not been reported yet [25].

Clinical pharmacists, community pharmacists, and GPs provided similar answers to the questions about the nature of the disease, non-cutaneous manifestations, and ways of transmission; this reflects a good knowledge about the disease's nature with responses > 90% in each group and fairly answered the proper incubation period (~ 50% correct answers in each group).

A low level of response across all study groups (less than 40%) corresponds to a gap in knowledge about hMPV cutaneous symptoms other than skin rashes and disease transmission other than direct contact with patients.

Skin lesions are the most noticeable sign (rashes, papules, vesicles, or pustules), which begin in the face and extend to the whole body in severe cases [26]. This finding may correlate to defects in case diagnosis, which correspond to ordering unnecessary laboratory tests and wasting governmental resources [27]. Earlier studies showed gaps in knowledge about non-cutaneous symptoms and human-to-human transmission [7, 9, 28].

Pharmacists have an increasing role in implementing preventive measures during emergent outbreaks. Moreover, community pharmacists administered COVID-19 and provided guidance and education to the public with satisfactory levels of confidence in many Arab countries [29].

However, another gap identified in this research is the knowledge about ways of transmission, prevention, and prophylaxis. From the previous results, it is very noticeable that all three groups have poor knowledge about vaccination available and other preventive measures; however, there was a statistically significant difference between community pharmacists and GPs.

These complement the results of a previous study, which highlighted the need to raise HCPs’ Knowledge about ways of transmission and subsequently implement proper disease control measures [7].

hMPV is a self-limiting disease that requires symptomatic treatment as antipyretics. Antibiotics are not recommended unless a secondary bacterial infection is a complication. Based on animal and human research, the European Medicines Agency (EMA) authorized tecovirimat, an antiviral drug licensed for smallpox, for hMPV in 2022 [30].

Smallpox vaccines are known to have high protection against hMPV. New vaccines are available, but neither the drugs nor the vaccines are freely available on the market  [23]. According to CDC recommendations, JYNNEOS (2-dose) for smallpox is the preferred vaccine for hMPV [3].

Most community pharmacists reported higher knowledge scores in questions related to disease preventive measures (merely 50%), which may correlate to the acceptable raising of infection control culture among the public.

However, community and clinical pharmacists and GPs reported comparable disease management and vaccination, which may correlate to similar confidence levels and skills in managing hMPV cases.

Unfortunately, 30% or more participants across study groups answered that antibiotics were among the treatment options for hMPV. Egypt and the Middle East suffer from antibiotic resistance; also, in the COVID-19 era, the consumption of antibiotics without clinical indication reaches its maximum [11, 31]. This particular issue needs a strict warning to HCPs and the public to avoid aggravating this problem.

By identifying the previously mentioned knowledge gaps, our main aim was to guide the Egyptian MOHP and other health policymakers to provide well-structured, evidence-based, and tailored training programs addressed to pharmacists and GPs separately about prevention and management to minimize the spreading of hMPV and other re-emerging infectious diseases.

After investigating the correlation between medical education and different questionnaire items among study groups, expectedly, medical education was positively correlated with high total knowledge scores among all participants.

Furthermore, medical education was associated with a raised knowledge about different disease aspects (disease nature, statistics, and incubation period) across all study groups and disease prevention, prophylaxis, and management for clinical pharmacists and GPs. Finally, medical education was associated with older age and females for GPs. On the contrary, a study on physicians found that younger participants had higher knowledge and was explained as better access to the Internet at a younger age [8, 32].

The previous result may be explained as older GPs would link to higher rates of acquiring training workshops and scientific conferences, which will be translated into higher knowledge and skills. As well as, older GPs are capable of consuming guidelines and have higher expertise in clinical practice [33].

The study was limited by the cross-sectional design, which limits causal associations. In such study design, recall and selection biases are inevitable.