This story about a study of how the shingles vaccine performs in regular clinical use does a nice job of putting the pros and cons of the vaccine in a larger context. We also applaud how this story addresses the potential harms of the vaccine. This story reports both the relative risk reduction (55 percent) and absolute risk reduction (from 13 to 6 cases per 1,000 people per year), but we wish it had told readers that 71 people would have to be vaccinated in order to prevent one shingles attack. We encourage broader use of this sort of statistic about the number of people you need to treat in order for at least one person to benefit. However, like the other stories, this one does not tackle the limitations inherent in this sort of observational study.
Shingles is a terribly painful condition caused by the chicken pox virus. It often reemerges late in life. Although a large clinical trial demonstrated that a vaccine could reduce the risk of shingles attacks and postherpetic neuralgia under idealized conditions, things are often different in the real world. This study of actual clinical experience adds an important perspective on the effects of the vaccine, but stories about this sort of study need to clearly address the limitations of observational trials and the ways that bias and confounding factors can muddy the results. Finally, the take-home message here is a clear need to promote shared decision-making between caregivers and patients on this issue, because this is not a slam dunk must-do vaccine.
The story reports that the vaccine can cost a couple of hundred dollars and that cost can put the vaccine out of reach for some people and that even people who could afford it may decide it is not as high a priority as other health care items.
Interestingly, while other stories about this study touted the finding that vaccination cut the risk of shingles by more than half, this story points out that compared to many other vaccines, a 55 percent reduction in relatively risk is a weak performance. The comment from one individual that the vaccine is “better than nothing” also helps readers put the benefits into perspective. The story does include endorsement of vaccination and descriptions of the terrible pain shingles attacks can inflict. It also points out that this study provides information about a reduction in the risk of serious eye problems caused by shingles that was collected by the clinical trial that led to the vaccine’s approval.
The story reports the absolute annual shingles attack risk figures of 6.4 per 1,000 among the vaccinated participants versus 13 per 1,000 among those not vaccinated. We would have like to also see the story mention that the results indicate that about 71 people need to be vaccinated to prevent one from suffering a shingles attack. And since the story reported relative risk reduction statistics for ophthalmic herpes zoster cases, it should have also told readers the absolute numbers.
The story should have pointed out that the study looked at a limited time span and that the researchers can’t say whether the effects of the vaccine persist through later years. That’s an important caveat, since a 60-year-old who had chicken pox as a child is at risk for a shingles attack for the remaining decades of life. If the vaccine cuts the risk of attacks in half, but only for the first few years after vaccination, then the lifetime reduction in risk would be much smaller.
Also, the final quote from an expert saying “the benefit, I think, is overwhelming” may overpower all the statistics, leaving readers with an unbalanced summary of the benefits of this vaccine.
So, while overall the story had a mixed performance on this criterion, we’ll give it a satisfactory score.
This story briefly refers to this vaccine providing protection against shingles “without many side effects.” While many stories would stop there (if they even acknowledged the potential for side effects), this report goes further to include the comment from an independent source that “I think it’s a very good vaccine, and it’s a safe vaccine, but obviously there needs to be continuing surveillance of usage of the vaccine to make sure there are no adverse effects that are seen in one in a 100 million cases versus one in five or 10,000 people.”
The story highlights the value of studying how the vaccine works in routine clinical use, rather than merely doing clinical trials under idealized conditions. It also notes that the people who were vaccinated “were more likely to be white, female and in better overall health than the unvaccinated people.” However, the story does not explain why these differences might be important to determining how much confidence to place in the study results. There should have been more attention to the inherent weaknesses and limitations of this sort of observational study, especially since the researchers called attention to potential sources of bias and their attempts to take those factors into account.
The story accurately describes the population for which shingles vaccine is recommended. It specifically notes that the vaccine is not recommended for people with “leukemia, lymphoma, HIV or an allergy to any ingredients in the vaccine.” It also includes comments about people discussing their eligibility for vaccination with a doctor. The story would have been better if it had more clearly told readers that most people do not have lasting effects after a shingles attack.
This story includes more than one independent source. The comments from these sources add valuable perspective on this study and the larger context of shingles vaccination. The story reports that the Kaiser Permanente health plan funded the study. However, it does not tell readers that some of the researchers have received funding from vaccine companies for other studies or consulting.
While it may seem that the decision to vaccinate is a simple yes or no matter, this story does a nice job of expanding the question to include other vaccination priorities. It includes comments that point out that shingles, while terribly painful, is not contagious or life-threatening… and that considering the high cost of the shingles vaccine, it may be reasonable to place a higher priority on other vaccinations. The story does readers a service by addressing some of the real world choices people face, rather than merely considering a single intervention in a vacuum.
The story reports that the vaccine has been available since 2006.
The story reports that this is the only approved vaccine to reduce shingles risk and that it has been available since 2006 in the United States. It also makes clear that this study provides information about how the vaccine performs in the real world, as opposed to the idealized conditions of a clinical trial.
The story does not appear to rely on a news release.