PONE-D-24-23371Assessment of Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi ArabiaPLOS ONE

Dear Dr. ALDALI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear authors, the manuscript needs major revisions, please respond point by point to the reviewers' requests.

Kind regards

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: No

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Excellent work, but please review some grammers and some words with capita letters make them with small letters. In the metod section there is wrong spelling in the month. Please add inclusion and exclusion criteria of the participants.

Reviewer #2: The following are important points for the manuscript.

1. Abstract:

1.1. In abstract, the method section is poor, it is not well written. It lacks important data such as statistical analysis, study variables, and population.

1.2. The result section in abstract is deficient and very poor, it is not supported by enough findings. It was written as if it is conclusion, no values or interpretations found.

1.3. The authors mentioned in result section that (Awareness of rubella's symptoms, like fever and rash, is common) and (Vaccination awareness and uptake are low).These findings are not supported by number or percentage.

1.4. In abstract, conclusion section is poor, it does not represent the findings.

2. Introduction: suitable and expressive.

The objectives are clear, and so the presentation

3. Methods : the methods are well described. The deficient point that the authors did not mention how the attitude is assessed. Under the section 2.4. Study Questionnaire Development, the authors described various parts of the survey without writing anything about the attitude although it was a main part in the title of the manuscript.

4. Results section:

This part is poor. The analysis is not satisfied. The authors did not write the assessment of attitude among the participants. I have observed the following deficient points:

4.1. The authors did not obtain the score levels of knowledge and attitude

4.2. The authors did not make comparisons among the participants such as males and females, marital status, education levels, and so on

4.3. The authors did mention the factors affecting the Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus.

I suggest the followings:

4.4. The authors should obtain score levels for Knowledge, Attitude, and Preventive Behavior, and compare the mean/median levels among the participants using chi-square test

4.5. The authors should add a regression table to demonstrate the factors that influence the Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: Yes:  Yosra Alhindi

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: report.docx

PONE-D-24-23371R1Assessment of Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi ArabiaPLOS ONE

Dear Dr. ALDALI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR:

Dear authors, the manuscript requires major revisions, please respond point by point to the reviewers' indications. 

Kind regards.

==============================

Please submit your revised manuscript by Oct 17 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: 1. Abstract:

1.1. In abstract, the method section is poor, it is not well written. It lacks important data such as statistical analysis, study variables, and population.

1.2. The result section in abstract is deficient and very poor, it is not supported by enough findings. It was written as if it is conclusion, no values or interpretations found.

1.3. The authors mentioned in result section that (Awareness of rubella's symptoms, like fever and rash, is common) and (Vaccination awareness and uptake are low).These findings are not supported by number or percentage.

1.4. In abstract, conclusion section is poor, it does not represent the findings.

2. Introduction: suitable and expressive.

The objectives are clear, and so the presentation

3. Methods : the methods are well described. The deficient point that the authors did not mention how the attitude is assessed. Under the section 2.4. Study Questionnaire Development, the authors described various parts of the survey without writing anything about the attitude although it was a main part in the title of the manuscript.

4. Results section:

This part is poor. The analysis is not satisfied. The authors did not write the assessment of attitude among the participants. The results are just percentage without interpretations. I have observed the following deficient points:

4.1. The authors did not obtain the score levels of knowledge and attitude

4.2. The authors did not make comparisons among the participants such as males and females, marital status, education levels, and so on

4.3. The authors did mention the factors affecting the Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus.

I suggest the followings:

4.4. The authors should obtain score levels for Knowledge, Attitude, and Preventive Behavior, and compare the mean/median levels among the participants using chi-square test

4.5. The authors should add a regression table to demonstrate the factors that influence the Knowledge, Attitude, and Preventive Behavior Regarding Rubella Virus

Reviewer #3: 1) Many grammar and editing errors 

 rubella --- r should be capital in the abstract and whole manuscript, but many are unclear about how it spreads.

2) The objectives should be smart (person, time, place) in the abstract and the whole manuscript (add the time).

3) in the abstract---------- The study included a total of 448 participants, all of whom were females (replace to be) (of 448 females (aged -------)

4) In the abstract, An online survey using Google Forms in English and translated into Arabic was used to record information----- an online Arabic survey using Google Forms --- no need to this detail in the abstract 

5) The term gender is a behavioral term, not a physiological term, so it replaces sex in the whole manuscript. 

6)  The combination of fever and skin rash was the most frequently reported symptom, accounting for 23.4% of all cases. ----- cases of rubella ----- Add a number before the %.

7)  Regarding the serious health risk, 55.4% of the participants were unsure of the situation.---- What does it mean I don't know or 

8)  in certain areas

 ---- females, women, cases, participants fix the term in the whole manuscript ---- to be females as in the title 

------ in the Kingdom of Saudi Arabia and  Saudi Arabia-----fix the term in the whole manuscript to be as in the title. 

-----This study aims to assess the level of awareness, attitudes,------- knowledge in others ---fix the term in the whole manuscript to be as in the title

9)  The KAP survey , US  -- add the full name for the first time 

10) in the abstract --- . Questions were included in the questionnaire to evaluate awareness of rubella, knowledge of symptoms, transmission, and preventative measures of rubella infection--------- where is the attitude 

and the awarness is part of the knowledge 

11) you discuss the global incidence in numbers in details ----- and The impact of this program over the years has been significant. The incidence of Rubella in Saudi Arabia has dramatically declined since the initiation of 

the vaccination program (17).------------------------ kindly add the numbers in detail 

12) add a brief about the   initiation of the vaccination program --- in Saudi Arabia (started when, achievement)---in the introduction 

13) what is your rational ---In Saudi Arabia, limited research has been conducted on this specific topic, making this 

study a valuable contribution to the existing body of knowledge--- add  reference .

14)  in the Department of Pathology, collage of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.------- why the department of pathology ??? 

15) In the Riyadh province of Saudi Arabia regional the sample size of 385 participants was 

sufficient to achieve 95% confidence with a 5% margin of error.----- as a  cross sectional study you need a prevlance or incidence (with refrence) --- and the total popoulation or females in Riyadh 

16)The second section focused on the 

information the Knowledge about rubella, specifically interested in their 

comprehension of the disease, their perception of the modes of transmission of rubella, 

their level of concern regarding it, their perspectives on the gravity of the virus, and 

their awareness of the impact of this virus on pregnant women and their embryos. The 

The third section focused on information about the symptoms caused by rubella. 

immunization status.  The last section focuses on preventive measures against rubella. -----  add refrence ????

17) The third section focused on information about the symptoms caused by rubella—its knowledge q 

 Rubella immunization status----- It is a part of preventive measures (rewrite).

19) while women comprise 96.2%.--- what does it mean

20) the age groups should be continous , and in order in table 1

25-<30

30-<40

40-<50

under 18-<25

years > 50

why the age intervals is not fixed ( 7 y then 4-year -10 year)

21) in all tables should be f not Effective

22) the symptoms should be calculated for each symptoms not merged

23) in knowledge study ---- should be total knowledge score

where does it then classify groups s that a fair number of participants are known of the rubella virus, but many are unclear about how it spreads---- what is fair mean

24) Table 5: Strategies for preventing rubella ---- should be the practice of preventive measure including vaccination status

11) where is the attitude tables ?

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  Samar Amer

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: report_declet_1.docx

PONE-D-24-23371R2Assessment of Knowledge and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi ArabiaPLOS ONE

Dear Dr. ALDALI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 06 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

Additional Editor Comments:

Dear Authors, the manuscript needs major revisions, please respond point by point to the reviewers' requests.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

Reviewer #5: All comments have been addressed

Reviewer #6: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

Reviewer #5: Partly

Reviewer #6: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: All comments have been addressed, and the manuscript has been updated. I recommend accepting this manuscript in its current form

Reviewer #5: Review Comments

Abstract;Not clear

Background:Weak

Methods: Not explicit and comprehensive

Result: Inadequate for the contents

Dicussion:Lacks theoretical and practical implications of the findings

Regards,

Reviewer #6: The grammatical errors and typo still need to addressed, as they cause confusion on the result and intended meaning.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #4: No

Reviewer #5: No

Reviewer #6: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

PONE-D-24-23371R3Assessment of Knowledge and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi Arabia: A Cross-Sectional StudyPLOS ONE

Dear Dr. ALDALI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR: Dear authors,the manuscript requires minor revisions. For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data. 

==============================

Please submit your revised manuscript by Feb 28 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

Reviewer #6: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

Reviewer #6: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #6: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

Reviewer #6: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

Reviewer #6: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: All comments have been addressed. This is the fourth round, and I suggest accepting the manuscript in its current version. I would like to thank the author for his effort.

Reviewer #6: I see that you've revised the paper before but I found some of the previous comments were not fully addressed and might be repeated in my comments. Here are a few concerns I have:

In the abstract: revise the conclusion section and the results should be stating facts and numbers only.

Introduction: try to give the section flow in terms of global data then regional data then from your specific context (eg you talk about the us then talk about global data then go to low and middle income countries)

Instead of group your findings to definitions and meanings(disease symptoms), disease epidemiology, knowledge related.

As the country of the study wouldn't be classified as low and middle income (poorer country) I don't see the need of focusing on findings from there

Previous reviewer suggested including vaccination information for Saudi, you haven't mentioned time frames also you haven't put statistical data that indicates the decline of the number if cases after the vaccine

According to your introduction there has been a decline in rubella cases, so what was the need to assess the knowledge among women (in addition to there being no other research with this topic, what is your justification for doing this research?)

Methods

Eligibility criteria is set before data collection so incomplete surveys would be categorized as missing or just incomplete, it wouldn't be an exclusion criteria, similarly male isn't an exclusion criterion

Please comment on how informed consent was obtained

You mention you went to different locations to gather contact information for the survey, wouldn't that create a selection bias? Did you use proportional allocation at the different sites?

It would be great if you could include validity, consistency and reliability scores for your survey (eg cronbach alpha score)

Who is the study population?at some point you say female students and others you say just female?

Use not up-to-date vaccination for the 92% instead of unvaccinated

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Reviewer #4: Yes:  Ahmed M. Alghamdi

Reviewer #6: No

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PONE-D-24-23371R4Assessment of Knowledge and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi Arabia: A Cross-Sectional StudyPLOS ONE

Dear Dr. ALDALI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

ACADEMIC EDITOR:

Dear Authors, the manuscript needs major revisions, please respond point by point to the reviewers' requests.

Kind regards

Please submit your revised manuscript by Apr 04 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments:

Dear Authors, the manuscript needs major revisions, please respond point by point to the reviewers' requests.

Kind regards

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

Reviewer #7: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

Reviewer #7: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #7: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

Reviewer #7: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

Reviewer #7: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: This is the fourth round of reviewing, and I have accepted the manuscript from the previous round; all my comments have been addressed

Reviewer #7: Title and Abstract: Abstract is clear and concise

Introduction: Introduction is enough if any current study mentioned that would be better.

Methodology

1- Study Settings and Design

• Please explain why do you choose the cross-sectional over Case control or longitudinal studies.

• Could you explain the data collection locations in Riyadh city did you cover major part of the city.

2- Study Subjects

• What was the study subjects recruitment methods?

• Clearly write the inclusion and exclusion criteria of the subjects.

3- Sample Size

• Clearly write why the final sample size (447) of the subjects are more than the calculated size (385).

4- Questionnaire Development

• Please write how did you validated the Questionnaire, what was statistical measures were used to see the reliability of the Questionnaire?

• Pilot results were seen on a very small sample size, like only 5 faculties were selected for this, which is very small size, there should be minimum 7 or more subjects for this pilot testing.

5- Ethical Issues

• Ethical approval was taken, but how did you obtained the informed consent?

6- Results Section

1- Demographic Features

• What was the reason for younger and more qualified subjects were more aware about rubella? You need to do more analysis to see these demographics effects on knowledge.

• Can you discuss more about the single participants that is 62.3% are notable, does the marriage status have any effect on attitude towards rubella?

2- Knowledge about Rubella

• Study findings shows that only 2.1% thinks that they are Very knowledgeable, discuss what is the reason for that?

3- Vaccination History

• Very low vaccination rate that is 7.5% received rubella vaccine that is a point of concern, it should be discussed in discussion, weather it is due to the healthcare accessibility, cultural or lack of awareness programs.

• Another findings that 47% subjects were unaware weather they have taken rubella vaccine, this is also point of concern, why it is so, do the primary healthcare centers do not communicate to the general public.

4- Discussion section

Knowledge Spaces

• What do you feel, why there significant gaps in knowledge about the rubella complications and transmission, discuss potential reasons for that.

• You can discuss more on the similar studies done in Saudi Arabia in different regions and compare it with your findings.

Vaccination Awareness

• Discuss and see other studies in Saudi Arabia and you can suggest how to come up with this low vaccinated rate in Riyadh.

Cultural and Social Reasons

• You can discuss whether some cultural belief, or misconceptions preventing subjects going for rubella vaccine.

Suggestions for Public Health

• You can suggest specific recommendations for healthcare providers to start educational campaigns about the transmission and complications of rubella.

References

• Most of the references are old and before 2020, it would be better to new studies done in Saudi Arabia or Middle East.

Overall the study has covered many aspects of rubella, after taking above points, manuscript will be off great contribution for rubella awareness, knowledge, prevention and control the complication and its transmission in public.

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #4: No

Reviewer #7: Yes:  Dr Irshad Ahmad

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Attachments

Attachment

Submitted filename: Plos One Review Comments.docx

Assessment of Knowledge and Preventive Behavior Regarding Rubella Virus Among Females in Riyadh, Saudi Arabia: A Cross-Sectional Study

PONE-D-24-23371R5

Dear Dr. ALDALI,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Omar Enzo Santangelo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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