This story about how the shingles vaccine performs in the real world takes a somewhat different tack from the HealthDay and Reuters stories we also reviewed. It includes discussion of a second study documenting low usage rates of the vaccine, but the story fails to give readers any comments from experts (like those quoted in the HealthDay story) who explain why some people have put a lower priority on the shingles vaccine. The story covers many of the basic points on the effectiveness study, though readers are not told what is new and different about this study compared to earlier research. There is a good description of who was included in this study, but little attention to the potential sources of bias inherent in this sort of observational study. In addition to reporting the 55 percent reduction in relative risk and the absolute risk reduction (6 versus 13 cases per 1,000 people per year), we wish this story had noted that the study found that 71 people need to be vaccinated in order to prevent one from having a shingles attack.
When this story discusses the study documenting low usage rates, it states that “doctors may not be aware of the new recommendation.” It could be argued that many doctors have been aware of the recommendations, but have had a healthy skepticism of the original study, and did not yet have the results of this current study, which is at least a start at getting information on the generalizability of the original study’s results. Many doctors may be cautious about immediately jumping on the bandwagon of a new vaccine. If patients are healthy, the onus is on the physician to provide more good than harm, especially in prevention.
Finally, the story is unbalanced when it ends with this comment without challenging it: “Once the patients learn about it, most are agreeable…”Everybody wants it…” Our medical editor who reviewe this story believes that many patients are cautious and/or skeptical of new vaccines (or any vaccines, for that matter), especially when the condition is shingles, and many patients do not think of the condition with “horror stories” but rather something usually self-limiting and also treatable.
This story includes a comment that “vaccine expense is another barrier for some” and that not all insurance plans cover the cost of this vaccine, but readers are not told that it can cost about $200. Nonetheless, we’ll give it the benefit of the doubt on this criterion since cost and insurance are at least addressed.
Although this story leads with only the relative risk reduction of 55 percent that researchers found in this study, it quickly places that effect in context with that of other vaccines (which generally provide greater protection). The story also reports the absolute risk figures of 6.4 cases per 1,000 people per year among those vaccinated and 13 cases per 1,000 people per year among those who were not vaccinated. These numbers help readers put the effects into the overall context of the risk of shingles. We think readers would have benefitted from also being told that based on the results of this study, one case of shingles is prevented for every 71 people vaccinated. This figure makes clear that while some people who are vaccinated are spared from a shingles attack, not everyone should expect to personally benefit from vaccination.
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.
The story reports that earlier research identified side effects of the vaccine, including redness and pain at the injection site. But an inquiring story would have asked about side effects in the new study.
Although this story did a better job than the other stories we reviewed in describing the participants of this study as members of the Kaiser Permanente health plan in southern California, like the other stories, it failed to address the potential sources of bias inherent in this sort of observational study. The study authors highlighted the limitations of the study design and explained what they did to try to identify and adjust for bias. The story should have given readers more information on these study limitations.
The story reports that this vaccine is recommended for people 60 and older. It also includes a comment about who should not get the vaccine, “including people with a compromised immune system and certain cancers.” Our medical editor on this story thought there was an element of disease-mongering in how the story didn’t emphasize that it is post-herpetic neuralgia that “can last months or even years” and by not then emphasizing immediately that most people with zoster do not have this condition. But we’ll give the story the benefit of the doubt on this criterion.
The story includes an independent source. However, the comments of the independent source don’t address the specific methods or findings of this study. Instead, they begin to wander off into a discussion of the relationship between stress and shingles attacks.
The story does tell readers that this study was funded by the Kaiser Permanente health plan and that the lead author has received support from the vaccine’s maker for other research.
As this story points out, less than 7 percent of people age 60 or older have gotten the shingles vaccine (while many more in that group have gotten flu, pneumonia and other vaccinations). The story should have addressed the reasons that so many primary care physicians and their older patients have decided that deferring vaccination against shingles is a reasonable option. The shared decision-making option of NOT being vaccinated was not given a forum here. Instead, the line: “Once patients learn about it, most are agreeable. “Everybody wants it, because they have heard all the horror stories,” (said UCLA’s Dr. Galler.)”
The story reports that this shingles vaccine has been available in the Untied States since 2006.
The story makes clear that this is the only vaccine approved to reduce the risk of shingles and that it has been available in the United States since 2006. However, it fails to explain what is new about the information provided by this study. The other stories we reviewed (HealthDay and Reuters) explained that this study offers a glimpse at how the vaccine is performing in the real world, as opposed to the idealized conditions of the clinical trial that led to the vaccine’s approval.
The story does not appear to rely on a news release.