Review articles

By Mr. Mahdi Abdulla , Mr. Muhammed R Siddiqui
Corresponding Author Mr. Mahdi Abdulla
University of Liverpool, - United Kingdom
Submitting Author Mr. Muhammed R Siddiqui
Other Authors Mr. Muhammed R Siddiqui
Mayday Hospital, 23 Malvern Road - United Kingdom TN24 8HX


Shingles, Media

Abdulla M, Siddiqui MR. Analysing the Media's Coverage of the Shingles Vaccine. WebmedCentral DERMATOLOGY 2011;2(4):WMC001850
doi: 10.9754/journal.wmc.2011.001850
Submitted on: 06 Apr 2011 12:39:29 AM GMT
Published on: 06 Apr 2011 07:04:05 PM GMT


The aim of this paper is to provide a structural review into the coverage of news regarding healthcare in different newspapers; particularly between national tabloids and broadsheets.The reason behind this is primarily because they hold significant influence in swaying public opinion regarding health and social care, which can later become focal to government policy change. However, there are concerns as to whether some stories are receiving disproportionately low coverage compared to other ones considered more ‘newsworthy’.To ascertain this, the recent reporting of the shingles vaccine being introduced by the government was scrutinised.Four different newspapers were selected for this task and over the four weeks analysed, to see how facts were portrayed to the reader and how they compare to issues in actual reality. 


History of shingles

Shingles is a disease that is known to have existed for centuries, with accounts of its presence going back to the middle ages. However, it was not until the late 1700’s that an English physician by the name of William Heberden, was able to distinguish it from smallpox ,paving the way for scientists in the 19th century to distinguish it from erysipelas. The turn of the 20th century saw the greatest advances in understanding the nature of the disease, when it was noted by physicians that younger people living with shingles patients, would later on develop chicken pox and a link between the two diseases was made. This was finally confirmed and proven by the mid 20th century by Thomas H. Weller, through his works on the isolation of cell cultures [1]. By the 1940’s, having noticed a progression of vulnerability with age, it was realised that the condition was of much greater concern to adults [2].
As with chicken pox, herpes zoster is caused by the virus varicella zoster. It is a group one Varicella virus that belongs to the Herpesviridae family and the subgroup Alphaherpesvirinae, in common with herpes simplex [3,4]. It consists of double stranded DNA within a nucleocapsid, which is also contained within a lipid envelope surrounded by glycoprotein spikes.
The majority of the population is usually exposed to varicella zoster from an early age, which becomes evident with the onset of a more common disease associated with the virus, chickenpox. It is spread mainly by direct contact with fresh skin lesions or by airborne transmission [5]. This leads to an initial infection of the respiratory mucosa, which is then followed by infection of the lymph nodes, where the virus replicates and subsequently spreads to the liver and spleen. The human immune response consequently works to eliminate it from the body. Nevertheless, it remains in a latent state in the dorsal root ganglion lying adjacent to the spinal cord, or in the base of the skull around the ganglion semilunare. Herpes zoster is caused by the reactivation of the varicella zoster, contained within a single sensory ganglion [6].
The virus is usually suppressed by cell mediated immunity, but if this is in any way compromised as in the case of lymphoma, immunosuppressive therapy, AIDS or aging, it can once again reactivate, thus leading to the onset of the condition [7]. The way it achieves this, is by replicating in the nerve cells. Individual reawakened virons subsequently travel down to the area of skin served by that particular nerve fibre [8,9].
Symptoms and Diagnosis
One of the main features of herpes zoster, is inflammation and blisters found across the skin. Pain may arise as a result of extensive growth of the virus, which leads to inflammation in infected nerves. One of the distinguishing characteristics of the rash that results from its infection, is that it usually marks out a certain dermatome with blisters symptomatic of few other conditions [10, 11]. If no rash develops, the disease may be difficult to diagnose immediately, in which case there are laboratory tests that can be used. The most common of these, is carried out on blood and searches for varicella zoster specific antibodies in the blood or lymph from the blister. Other tests may involve collecting lymph for use in Polymerase Chain Reactions (PCR), or simply using electron microscopy to search for virus particles [8].
The virus symptoms will usually begin to subside after about three to five weeks. What is of most concern to most patients, is the onset of postherpetic neuralgia, as is the case in about 20% of sufferers [8]. This is a painful condition, that arises as a result of nerve damage inflicted by herpes zoster in a particular dermatomal signal and results in abnormal electric impulses being transmitted to the brain. It may continue for months or even years and can be seriously debilitating and difficult to manage. In some cases, the seriousness can be compounded by pain extending across a single nerve in the absence of a rash; the result of which can vary in its severity and in worst cases lead to conditions such as aseptic meningitis or cranial neuropathies. Other complications that may arise include temporary facial paralysis and encephalitis. Studies have suggested a weak correlation between the development of strokes and certain cancers with herpes zoster. However, this may be a consequence of the immunosuppression that can eventually lead to the onset of shingles [8].
Shingles is a relatively common condition with over 25% of the population above the age of 45 being affected by it. This figure may rise to around 30% in females and drop 20% for males; explained, in part, by longer life expectancy in women as well as Varicella-specific cell immunity decreasing with age. However, incidence can occur at any time, with 8.6% of males and 10.5% of females developing it before the age of 45 [12].
With shingles, the usual aims of treatment are to limit the severity and duration, as well as avoiding complications of the disease. One of the main treatments administered to sufferers is antiviral medication. The most commonly used of these is Acyclovir, which works by disrupting viral DNA metabolism. It is given as a prophylaxis, as well as in therapy in the acute phases and is preferably administered 72 hours after the emergence of a rash in individuals over the age of 50 [13]. To manage the pain, over-the-counter analgesics such as calamine, are usually administered to a rash or blister [14].
Vaccines are available to counter the onset of herpes zoster. The most widespread of which currently available is marketed under the brand name Zostavax [7]. As of yet, the current policy that is in place throughout most European countries including the United Kingdom, is that population based immunisation for shingles is not practiced. Instead, the official line from the UK Health protection Agency, is that while the vaccines may be offered to healthcare professionals who may not have developed immunity to the varicella zoster virus, this will not be extended to a full scale, population-based, childhood immunization scheme [15]. The reasoning behind this, is that adults as well as children may benefit from routine exposure to the virus, as a means of bolstering their body’s immune defences in later life [16].
The main aim behind this SSM ,is to critically analyse and evaluate the media’s coverage on government plans to introduce a vaccination program to prevent the onset of shingles.


The first thing that was carried out, was background reading into the nature of shingles.  A search was subsequently undertaken, in order to gain a deeper insight into the topic.  This was done using a number of databases including Medline, Ovid, Science Direct, Google Scholar and Pubmed.
After this was completed, limits were placed in order to find the stories most relevant to the aim. The limits were based on:
    * Types of article- Randomised clinical trials, Meta analysis, Reviews and Editorials.
    * Language- English
    * Species- Human
    * Ages- All
    * Type of text- Full text
In order to find articles that could be critically analysed and relevant to the topic, the search engine News Now, News UK and LexisNexis were used. Our limits were based on:
    * Type of coverage- Major mentions
    *  Types of newspaper-National newspapers
Date-Past 6 months.


Article 1-Row over age limit for shingles vaccination (The Guardian) [17]              &nb sp;       
The use of sensational language can be seen early on in the title, where the word “Row” immediately suggests there is a fair amount of controversy involved. In addition to this, the use of the term ‘age limit’ can suggest inevitable exclusions, thus drawing the attention of the reader. It elaborates further in the subheading, detailing the opposition behind the plans.
It gives a figure of “an estimated 250,000 people a year”, which is a high enough number to portray to the reader that this is an issue of legitimate concern. Furthermore, it also provides statistics such as 30% of sufferers developing postherpetic neuralgia, which seems to be a very high proportion for such a serious condition. The mention of it being the main cause of death in 100 people may seem meagre, especially when it adds that the vaccination program could encompass protecting over 4 million individuals.
It describes shingles as a “painful infection that can cause pain, scarring, sight loss and sometimes death in older people”. From this statement, one could also assume that the disease only affects older people. However, this is inaccurate as although it may be significantly greater in people above 50, it can present at any age.
Figures are quoted from the Joint Committee on Vaccination and Immunisation (JCVI), whose points have been backed up by Dr. Ian Donald of the British Geriatrics Society. This gives the proposals much more credibility since, to the average reader, as it seems to have been approved by organisations specialised in the two fields of vaccinations and geriatrics. The article then tries to balance this out with a quote from someone from the Shingles Support Society, who identifies that the risks actually begin to increase sharply after the age of 60; significantly before the age proposed for this vaccination.
Later on it accurately, albeit briefly describes the pathology behind shingles, as well as symptoms. The information that is quoted from the Department of Health is overall correct and in line with other sources. The author uses emotive language such as “unendurable”, “misery” and “horrendous”, as well the comparison with an unending childbirth. This seems to be very effective in emphasising how serious this condition actually is.
Finally, the article ends by describing this less from a personal perspective and more as part of a wider government strategy, which also hopes to reduce the risk of other diseases such as swine flu and cervical cancer. These are two diseases that have received a large portion of health coverage in recent years and by mentioning this, it demonstrates to the reader that this disease is of similar priority.
In general, the coverage was fairly accurate with plenty of facts to back up the statements made and is fairly balanced, having provided an opposing view to the proposals. Above all, it has highlighted the relevance of this topic to society, in a way that was clear and accessible.
Article 2- Jab for shingles to offered to everyone in their seventies (The Telegraph) [18]
One of the main features in this article, is that it describes how the jab will be comprehensive for everybody between the ages of 70-79. The JCVI is referred to as the “Government’s independent committee on immunisation”, which makes it seems to be more credible in the eyes of the reader, as it suggests they are free from any government or commercial interference.
The use of the word “debilitating” and “painful” could be seen as effective descriptions that may actively convince the reader of the reasons as to why this vaccine must be introduced. Also, the article has been written mostly by quoting other sources and therefore shows very little bias.
It includes statistics such as one in four adults developing shingles in their lifetimes, as well as 50,000 people over the age of 70 developing the disease each year. However, these numbers are meagre and are unlikely to influence the general public in realising the seriousness of the issue.
Overall, the article is accurate and information presented is academically correct, backed up by facts and statistics. However, it is very brief and the coverage and does not include any views and therefore is unlikely to draw up very much interest from the wider public.
Article 3- Shingles vaccine proposed for all those in their 70s- (Mail on Sunday) [19]
From the title, we can see that the language used is not very inflammatory .Its reasoning as to why the vaccine is being given is that “can lead to sufferers being hospitalised”. This is somewhat vague, but not necessarily inaccurate.
The article goes on to mention that one quarter of all adults will go on to develop shingles in their lives, as well as symptoms such as “painful rash and blisters”, though makes little more effort to provide further facts or statistics.
At certain points, the article may play down the seriousness of shingles, saying the programme “has not been triggered by any particular concern”. Later on, it makes mention of the “cost-effectiveness” aspect of the statement by the JCVI. However, it fails to point out other considerations included in the JCVI statement, such as the epidemiology as well as medical and vaccine safety that has led them to this decision [20].
It finishes off with a quote by the minister for public health Gillian Merron. It states that this would be “good news” for people in the 70’s, as it would improve their “quality of life”. Considering the experiences of people with the disease, we can say this is fairly accurate.
Overall, the language used in the article is very understandable and avoids exaggerating the topic too much.  However, it makes little use of statistics to back it’s points and instead only quotes government figures, lacking further insight into the topic or opposing points of view. This not only makes it difficult to determine the accuracy of what is being said, but is unlikely to help the reader consider the real importance of the proposals.
Article 4- Shingles Jab for the Elderly (Daily express) [21]
The author of the article has not been included and therefore it is difficult to hold any individual account for what is being said. The title it uses is very simple, but uncaptivating and lacks any further information that can draw the attention of the reader. Furthermore, it refers to the possibility of “pensioners” being offered the jab under the plans which is misleading and erroneous, as the term could suggest anyone over the retirement age of 65, while plans are only for those between the ages of 70 and 79.
It continues by explaining how the virus develops in people who have had chicken pox during childhood. However, it fails to elaborate on how it can create significant discomfort and can have a serious impact on quality of life. This can lead the reader to assume that the severity of this condition is comparable to common childhood chickenpox, which in many cases is far from true.
It ends off with some scaremongering, quoting Jackie Fletcher of the Vaccine Damage Support Group as saying: “We are becoming more dependent on vaccines on out natural immunity meaning, we will need more vaccines along with the risk”. From the name of the group, the reader may be convinced into thinking that this is entirely true. Yet, the article fails to make mention that it is in fact within government policy to limit vaccines for herpes zoster and allow for natural immunity to develop. However, in older people, especially those over 70, natural immunity will be significantly reduced, putting them at a heightened risk of a reactivation of this virus.
Overall, this article seems to be very vague and in some places may even trivialise the severity of shingles as a disease. It lacked statistics to back up the factual points it made, which would make it difficult for the reader to have an informed view into the program and what exactly it entailed. The reason for this could be because, with so few mortalities associated with the disease, there is little that can be included that can be considered exciting and newsworthy.  Though the language used may be simple and accessible to the layman, it lacks overall appeal and is unlikely to draw up much interest.
Future Studies
In future, studies should be carried out to see how this story unfolds as the government implements its policy. Of particular interest, is the efficacy of the vaccine in reducing the number of cases of shingles and the effect this has on overall quality of life for those vaccinated.


The media’s coverage of the shingles vaccine may be considered unfair. The primary reason for this is because the story’s importance has generally been trivialised. This could be because of an association of herpes zoster with common childhood chickenpox. Also, because so little mortality is actually associated with the disease, the newspapers missed out on the importance of this vaccine in improving overall quality of life, particularly for the elderly.  Added to this, the story may only concern those in their 70’s, who constitute a small sector of society. Nevertheless, the newspapers analysed had in large part refrained from using language that could be deemed to be too inflammatory and covered the story with a fair degree of neutrality.


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