Abstract
BACKGROUND: Mosquito-borne arboviral infections (MBAI), including dengue and chikungunya viruses transmitted primarily by Aedes species and West Nile virus (WNV), transmitted mainly by Culex species, are increasingly reported in Europe. For Aedes-associated arboviruses, climate change and globalization contribute to the spread and establishment of competent vectors, while for WNV, climatic factors such as temperature and host-vector dynamics may enhance transmission in areas where the virus is already present. Physicians play a key role in early recognition and prevention of MBAI, yet data on their knowledge, risk perceptions, and practices (KPP) in non-endemic settings remain limited. METHODS: We developed a 44-item questionnaire to assess KPP related to arboviral infections. We conducted a cross-sectional survey between May to October 2024 using EUSurvey an opensource web-based tool, among all general practitioners, internists and pediatricians registered with the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg (KVBW). Descriptive statistics were computed. Composite domain scores were calculated and normalized (0-100 scale). Associations between domains and predictors were examined using non-parametric tests, Spearman correlation, and beta regression models. Multiple comparisons were adjusted using the Benjamini-Hochberg method. RESULTS: A total of 473 physicians participated in the survey (response rate of ∼6%); 55.8% were women and 60% were aged 40-59 years. The median normalized scores were knowledge 68.6 (IQR 55.4-79.7), perception 33.3 (26.7-46.7), and practices 54.6 (37-68.5). A majority of respondents, 75.8% (N = 354) reported only partial knowledge on arboviral transmission routes. 68.9 % (N = 324) desired more information on endemic regions for arboviruses. In a clinical vignette (fever with truncal exanthema after travel to southern France), 42% would order arboviral testing, compared to 90% for a pregnant traveler returning from Brazil. Over 73% (N = 341 of 462) physicians reported a no to low risk of autochthonous West Nile virus (WNV) infections, and only travel-associated indication was widely recognized (89.4% (N = 373). Knowledge and perception scores were positively associated with practices (OR: 1.16 [95% CI 1.11-1.21] and 1.14 [1.09-1.20], both p < 0.0001). CONCLUSIONS: This first survey of physician KPPs on MBAI in Germany highlights substantial knowledge gaps, misaligned risk perceptions, and travel-centric diagnostic mindset, where the risk of infections locally and within Europe was underrecognized. Despite a low response rate, this study provides a valuable reference point for preparedness planning. Integrating arbovirus-related content into continuing medical education, supported by public health information campaigns and surveillance feedback, are likely to contribute to strengthening clinical awareness and may support improved diagnostic and counselling practices in the face of expanding vector presence and increasing risk of autochthonous infections.