The emergence of a global health emergency requires rapid response and preventive measures to limit its spread at the national and international levels. The increase in the number of Monkeypox (MPox) cases in several regions of the world has led nations to adopt precautionary measures to avoid the negative impacts of this disease [1] [2] . It takes approximately 14 to 21 days for the symptoms of Mpox to disappear on their own. However, its severity is variable and can range from mild to severe, including symptoms such as fever, headache, fatigue, muscle pain, lymphadenopathy, back pain and itchy or painful rashes that characterize the disease [3] - [5] . It is possible that complications can lead to death [6] . The initial pandemic epidemic in Africa was marked by the presence of two clades with notable epidemiological and clinical differences [7] . There is a need for short-term emergency training to enable frontline health professionals to effectively diagnose and manage emerging cases while adopting adequate protective measures to reduce the risk of infection and virus transmission [8] . Prevention of human-to-human transmission relies on early detection, case isolation, contact tracing and vaccine introduction to manage the current global epidemic [9] . A comprehensive approach including vaccination, an adequate supply of equipment, enhanced surveillance, rigorous disease control and cross-border cooperation at the international level is also essential. Public education also plays a key role by emphasizing the reduction of exposure risks through limiting sexual partners, avoiding contact with travelers from affected areas or with potential carrier animals and restricting travel to endemic areas [10] [11] . In the United States, 2891 cases were reported between May and July 2022, 94% of which were associated with sexual intercourse with frequent genital and anal lesions but not lethality . In Montreal, in October 2022, 402 cases of Mpox were reported, mainly involving sexual transmission; the median age was 37 years, and no deaths occurred due to rapid genomic surveillance and a targeted community response focused on rapid vaccination of at-risk individuals [12] . In the UK, predominant sexual transmission and the presence of viral DNA in semen were reported for several patients in 2022 [13] . In Africa, MPOX is endemic in several countries, such as Nigeria, between 2017 and 2018; 122 patients were confirmed to have a 39% hospitalization rate and a case fatality rate of 6%. The distribution of cases and contacts suggested primary zoonotic transmission and secondary human-to-human transmission [14] . Mpox cases after the cessation of smallpox vaccination campaigns were reported in 2010, with a lethality greater than 9% [15] .

In Guinea, the Ebola resurgence in 2021 was quickly brought under control thanks to urgent in-depth mobilization and multisectoral coordination, despite the difficult context. Actions focused on the key pillars of the response made it possible to limit the spread and save lives [16] . However, the first case of Mpox infection was reported in the forest region beginning in September 2024, but data on response strategies to this epidemic are limited; hence, the interest in this topic was limited. The objective of this research was to study the success factors in the response to the Mpox epidemic in Guinea.

The success of the response to the Mpox epidemic depends on the capacity of local health systems to rapidly coordinate interventions and mobilize resources. We conducted this cross-sectional study with the aim of identifying the factors influencing the success of this epidemic in Guinea. Several studies highlight that the effectiveness of health responses depends on the availability of structured coordination teams, rapid interventions and human resources trained in surveillance and case management [20] [21] .

In our series, the profile of response actors was dominated by young participants with a secondary education and nurses. Health personnel, particularly nurses, occupy an essential place in the prevention and control of epidemics within hospitals and clinics worldwide [10] . Our results highlight the need for targeted strengthening of the surveillance and care skills of response personnel.

Almost all of our respondents believed that the population was informed about the existence of the disease, thus reflecting an effective communication strategy. According to the literature, early detection and management of epidemics can be optimized through community surveillance by mobilizing community members to ensure local health monitoring [22] . A European series argued that emergency management is based on an essential pillar that is composed of risk communication, community engagement and infodemic management [23] . Community mobilization can be achieved through this approach, which is essential for the effective management of an epidemic through the early detection of cases, the acceptance of public health measures and the reduction of stigma.

Clinically, the affected subjects were young, and clade II was predominantly reported. HIV was the most common coinfection. According to data from 16 countries between April and June 2022, 41% of patients were infected with HIV, with a median age of 38 years [24] . The circulation of clade II viruses in the West African region is supported by the literature, as clade II viruses are responsible for epidemic outbreaks in this region [25] .

In this study, multivariate analysis revealed that the presence of a coordination team, rapid intervention, surveillance and management are significantly associated with the success of the response. Our result is supported by data from a systematic review calling for strengthened international support for surveillance so that the detection of Mpox cases is fundamental to monitoring the evolution of the dynamics of the epidemiology of this re-emerging disease [26] . This demonstrates that the performance factors of a response depend on the capacity of the country’s health system to organize and quickly deploy human and material resources.

In addition to the strengths reported above, our study highlighted major deficiencies in the response sector focused on the lack of vaccines against Mpox and drugs for management as well as the absence of adequate laboratories for the analysis of samples in the majority of prefectures. However, the literature recommends that public health strategies integrate the strengthening of health infrastructures to improve surveillance systems to guarantee equitable access to vaccines and treatments [27] . These identified deficiencies can compromise the capacity to effectively diagnose, treat and prevent new cases.

The existence of an isolation site, suitable equipment and, above all, standardized management guides were also associated with the effectiveness of the response. Our result is supported by the fact that isolating patients upon detection at appropriate sites significantly reduces transmission [28] . Hence, there is interest in having a clear and available regulatory framework with adequate infrastructure to contain the disease.

Our study also reported that the majority of staff members reported having been trained but that the number was insufficient. This finding is in contrast to that of a Turkish series reporting that up to 95.8% of nurses had not received any specific training on the MPOX [29] . This justifies the crucial need to strengthen these human resources to balance the tension between the technical capacities of staff and their volume.

One limitation of this study is that it is cross-sectional and based on declarative data susceptible to memory bias and social desirability, despite which it provides a relevant and contextual basis for strengthening Mpox response strategies in resource-limited settings.

This study highlights the importance of a responsive healthcare system based on effective coordination, qualified human resources, and adequate logistical means. Key success factors include the presence of a coordination team, a rapid response team, staff for care and surveillance, as well as isolation sites, appropriate equipment, and guidelines for the management and surveillance of the Mpox response. To ensure the sustainability of these gains, it is crucial to strengthen coordination teams and regularly update the normative documents related to care and surveillance.

The data generated and/or analyzed during this study are available from the corresponding author upon reasonable request.

A special thank you is extended to the General Directorate of the National Health Security Agency for their valuable support.