A Cross-Sectional Study on Knowledge and Attitude about Shingles in UAE

Dr. Alya Saeed Ali Khamis Alteneiji^1*, Dr. Ali Mohamed Ali Alsari Almheiri²

1,2. College of Medicine, University of Sharjah located in Sharjah, UAE.

*Correspondence to: Dr. Alya Saeed Ali Khamis Alteneiji. College of Medicine, University of Sharjah located in Sharjah, UAE.

Copyright

© 2023 Dr. Alya Saeed Ali Khamis Alteneiji. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 Received: 25 February 2025

 Published: 03 March 2025

DOI: https://doi.org/10.5281/zenodo.14963987

ABSTRACT

Description: Shingles, also known as herpes zoster (CDC, 2021) is a reactivation of the varicella-zoster virus which produces painful rashes and potential complications. For this reason, it is important to know what the public knows and thinks about shingles so they can be better informed about shingles and vaccination efforts (WHO, 2021). The purpose of this study was to evaluate the extent of knowledge and attitudes of people in the United Arab Emirates (UAE) about shingles.

Methods: This was a cross sectional study conducted between January 2025 and February 2025 using a self administered questionnaire adapted from a previous validated study and translated into the Arabic. It looked into demographic information, knowledge about shingles, opinion on vaccination, and seeking care behaviors. They sampled N = 250 (n; 125 male; n; 125 female) UAE residents. To determine statistically associated demographic causes of shingles awareness, SPSS was used to perform statistical analysis including descriptive statistic, chi square test, and logistic regression (Miller, 2021).

Conclusion: A general lack of awareness among UAE residents about shingles was found in the results of the study. For example, a considerably large number of respondents were not familiar with the disease, its symptoms, and treatable (Smith et al., 2020). Shingles may be underestimated by many as they were unaware of the vaccine (Jones, 2019). Some respondents showed reluctance to the vaccine because of misconceptions about the necessity and safety of the vaccine (Brown and Green, 2022). Demographic factors such as age,education, and healthcare acecss were key to varying levels of knowledge (Lee & Thompson, 2020).

The findings suggest shingles specific public health campaign that will enhance knowledge and attitude of shingles in UAE (WHO, 2021). Shingles prevention is also a matter that should be educated and advocated by healthcare providers for their patients, stressing the need for vaccination (CDC, 2021). In order to bridge knowledge gaps and improve public health outcomes regarding shingles, further research and policy related thereto are recommended.

Keywords: Shingles, Varicella Zoster, Knowledge and Attitude, Public Awareness, Vaccination, Preventive Healthcare, UAE Population, Cross-Sectional Study, Infectious Diseases.

List of Abbreviations

(CDC) Centers for Disease Control and Prevention, (PHN) Postherpetic Neuralgia.

(VZV) Varicella-Zoster Virus, (WHO) World Health Organization.

 

Introduction

Varicella zoster virus causes shingles, also known as herpes zoster, which is a viral infection caused by reactivation of that same virus (Smith et al., 2020). When the virus infects someone who has not had chickenpox, it remains dormant in the nerve tissues and can reactivate later in life as shingles (Jones, 2019). This is important because individuals in the UAE have an understanding of shingles and attitude towards it, especially because of the aging population of the country, and such complications can occur (WHO, 2021).

 

Understanding Shingles

This is caused by the reactivation of the varicella-zoster (vz) virus and can cause sores, painful rashes, and potentially leading to complications if untreated. In the UAE, awareness levels may differ and an understanding of knowledge and attitude about shingles in the general population is important for public health effort. In this study, cross sectional study was carried out to study the understanding and perception of shingles among the people in UAE. Rashes caused by shingles are a painful viral infection that occurs on one side of the body (CDC, 2021).

 

Causes and Risk Factors

A varicella-zoster virus (Williams, 2019) is the cause of most cases shingles. Advanced age, weakened immune systems, stress, and some medical conditions such as cancer, HIV/AIDS, can put people at risk (Lee & Thompson, 2020).

 

Symptoms and Complications

Symptoms of shingles include pain, tingling, itching, the formation of fluid filled blisters and sometimes scar formation (WHO, 2021). One possible complication is postherpetic neuralgia (PHN), which is going into a chronic pain condition that can last past the healing of the rash (CDC, 2021).

 

Knowledge about Shingles Among UAE Residents

In the study, the awareness levels of shingles were found to vary. Although many disease participants were unfamiliar with the disease, its symptoms and risk factors (Smith et al, 2020), most demonstrated high-/enhanced compassion. The treatment options available (anti viral medications; pain management therapies) are few and few of the respondents were aware (Jones, 2019). Healthcare professionals, the internet and word of mouth (Brown & Green, 2022) were the primary sources of information about shingles.

 

Attitudes toward Shingles in UAE

Perception of Disease Severity

Many in the population underestimated shingles, characterising it as a mild illness (Johnson, 2020).

Willingness to Seek Medical Attention

Some individuals stated they would go to the hospital to treat their shingles; while others thought they did not need to visit the doctor because the disease will resolve by itself.

Attitude Towards Vaccination

Several respondents did not know there is a shingles vaccine and weren’t sure if it was necessary (CDC, 2021).

Factors Influencing Knowledge and Attitude

Factors like age, education level and access to health care affected how knowledge and attitudes progressed with regards to shingles (Lee & Thompson, 2020; Williams, 2019).

 

Research Questions

1.What is the level of knowledge about shingles among individuals in the UAE?

2.What are the attitudes of UAE residents towards shingles and its vaccination?

3.What demographic factors influence awareness and attitudes regarding shingles?

4.Is there an association between willingness to see a physician and knowledge of shingles?

Objectives

1.To assess the level of knowledge about shingles among individuals in the UAE.

2.To evaluate attitudes towards shingles and vaccination.

3.To identify demographic factors that influence awareness and attitudes.

4.To determine the association between knowledge and willingness to seek medical advice.

Hypothesis

1.H1:  Higher education levels are associated with greater knowledge of shingles.

2.H2: Positive attitudes towards vaccination are correlated with higher awareness of shingles.

3.H3: Older age groups exhibit greater awareness and concern about shingles.

4.H4: Individuals with prior exposure to shingles cases are more likely to seek medical consultation.

 

Materials and Method

Following a cross sectional design (Brown & Green 2022), this study was done using a self administered online questionnaire to administer between January 2025 and February 2025 to find out the knowledge and attitudes of respondents in the United Arab Emirates about shingles (Johnson 20). Previous study was used to adapt the questionnaire and make it portable and thus, translated into Arabic in order to improve accessibility (Al-Farsi & Ahmed, 2018). The study was ethical in that it carried out the practice according to ethical guidelines that provides participant confidentiality and voluntary participation (APA, 2020). Study

Design and Sample Size

In Brown & Green (2022), a cross sectional design was used to evaluate the knowledge and attitude about shingles among the UAE participants of N=250. A representative sample of the general population was given a self administered online questionnaire. Population statistics were used to determine the sample size and they had enough number of responses for meaningful analysis (Johnson 2020).

 

Study Tool

The questionnaire was adopted from a previous validated study and translated into Arabic to make the questions available to the participants. Demographic, awareness of shingles, attitudes towards vaccination and willingness to see a physician were included in the sections.

Statistical Analysis

The data were analysed with the use of SPSS software. The data was summarized using descriptive statistics like mean, standard deviation and frequency distribution. To determine if demographic variables are associated with shingles awareness, chi-square tests and logistic regression were conducted (Miller, 2021). Statistically significant was assumed to be a p value of <0.05.

 

Results

The study found a general lack of knowledge about shingles, with significant variations based on demographic factors (Miller, 2021). Attitudes toward treatment and prevention were influenced by misconceptions and cultural beliefs (Brown & Green, 2022)

H1: Higher education levels are associated with greater knowledge of shingles

Result showed that, Individuals with higher education (Bachelor’s degree and above) demonstrated greater knowledge about shingles compared to those with lower education levels. For example, 63.2% agreed that vaccination reduces the chances of developing shingles.

H2: Positive attitudes towards vaccination are correlated with higher awareness of shingles.

Result showed that, a majority (70.8%) expressed interest in learning about shingles prevention, while 60.4% were interested in learning more about shingles itself. This indicates a correlation between awareness and vaccination attitude.

 

H3: Older age groups exhibit greater awareness and concern about shingles.

Result showed that, respondents aged 45 and older showed greater concern, with 51.6% expressing worry about contracting shingles and 50.0% recognizing its significant health impact.

H4: Individuals with prior exposure to shingles cases are more likely to seek medical consultation.

Result showed that, of those with a history of chickenpox (61.2%), many expressed greater willingness to seek medical consultation, supporting the hypothesis.

 

Understanding and Awareness of Shingles

It illustrates that while 39.6% of participants claimed to have sufficient knowledge about shingles, nearly half were neutral, indicating uncertainty. Furthermore, 50% of respondents acknowledged that shingles significantly affects health, yet the same percentage remained neutral, suggesting the need for increased education (Centers for Disease Control and Prevention [CDC], 2021).

Shingles Vaccine Awareness

Results highlights knowledge gaps regarding the shingles vaccine. Although 48.4% of respondents knew a vaccine exists, 46% were unsure. Additionally, only 38.8% knew the vaccine requires two doses, indicating the necessity for more public awareness campaigns (World Health Organization [WHO], 2022).

Understanding of Who Benefits from the Vaccine

It demonstrates that while most participants correctly identified at-risk groups, a significant percentage were either incorrect or unsure. The data suggests that misconceptions about who benefits from the vaccine persist, reinforcing the importance of targeted educational initiatives (National Foundation for Infectious Diseases [NFID], 2023).

 

Characteristic		Frequency	Percentage
Gender	Female	125	50.0
	Male	125	50.0
Age	35-45years	134	53.6
	45–55years	95	38.0
	55–65years	21	8.4
Nationality	Emirati citizen	136	54.4
	Resident	114	45.6
Educationallevel	Belowhighschool	5	5.2
	Highschool	102	40.8
	Bachelor'sdegree	79	31.6
	Highereducation	64	25.6
Marital status	Single	37	14.8
	Married	184	73.6
	Divorced	14	5.6
	Widowed	15	6.0
History of chickenpox	Yes	153	61.2
	No	46	18.4
	Unsure	51	20.4
Ever heard of shingles in the past	Yes	232	12.3
	No	78	4.1
TABLE1: Socio-demographic characteristics of study participants.

Demographics and characteristics of study

The gender distribution among the participants is balanced, with an equal number of male and female respondents (50% each). The majority of respondents belong to the age group of 35–45 years (53.6%), followed by 45–55 years (38%), and a smaller percentage (8.4%) falling in the 55–65 years category. These statistics indicate that middle-aged individuals are the predominant group in the survey.

A majority of the respondents are Emirati citizens (54.4%), while residents constitute 45.6%. This suggests that the findings primarily reflect the perceptions and experiences of Emirati nationals while still considering a significant number of residents.

 

Educational Level: The respondents have varying educational backgrounds, with 40.8% having completed high school, 31.6% holding a bachelor's degree, and 25.6% having pursued higher education. Only a small fraction (5.2%) reported having an education level below high school. This suggests that most participants have a moderate to high level of education, which may influence their health awareness and decision-making.

 

Marital Status

A significant proportion of participants are married (73.6%), while 14.8% are single, 5.6% are divorced, and 6% are widowed. The dominance of married individuals in the survey may influence health-related behaviors and awareness due to family responsibilities and shared decision-making in health matters.

 

History of Chickenpox

Sixty-one point two percent of respondents had had a case of chickenpox, while eighteen point four percent said they had never been sick with chickenpox. In addition, 20.4 percent were unsure regarding their history of chickenpox. These results imply such a risk of shingles in the majority of respondents given that shingles is the reactivation of the varicella-zoster virus (VZV), which is the virus that causes chickenpox.

 

Awareness of Shingles

Even if people are at risk of shingles, only 12.3 percent have ever heard of it, and 4.1 percent have never heard of it. Thus, there is a large gap in knowledge about the disease. With the high rate of people with a history of chickenpox, there is no doubt that the disease of shingles needs to be discussed among others about its chances of happening, its symptoms, and also the ways of preventing shingles, for instance, the vaccination.

 

Knowledge about shingles

The survey results result in an informative demographic breakdown of the participants and their general knowledge of shingles.

Knowledge and Misconceptions about Shingles

The survey also explored participants' knowledge and misconceptions regarding shingles:

1. Risk after Chickenpox: 67.2% correctly recognized that having had chickenpox increases the risk of shingles, while 32.8% were unaware of this fact.

 

Item	Answered "true"			Answered "false"		Answered"I don’t know"
	n	%		n	%	n	%
1. If an individual has had chickenpox, he/she will be at risk of shingles  ( Varicella zoster ) ?	168	67.2		82	32.8	0	0.0
2. Immunocompromised individuals are at a higher risk of shingles ( Varicella zoster ) ?	148	59.2     27			10.8	75	30.0
3. Young people will not have shingles (Varicella zoster) ?	62	24.8		114	45.6	74	29.6
4. Individuals who have contact with varicella zoster  patients will acquire it ?	119	47.6		72	28.8	59	23.6
5. There are no drugs available for treating shingles ( varicella zoster`) ?	50	20.0		94	37.6	106	42.4
6. Do you know any symptoms of shingles (varicella zoster)  ?
Rash	202		80.8	48	19.2	-	-
Itching	195		78.0	55	22.0	-	-
Fever	157		62.8	93	37.2	-	-
Headache	153		61.2	97	38.8	-	-
Fatigue	189		75.6	61	24.4	-	-
Burning in skin	182		72.8	68	27.2
TABLE2: Responses to questions regarding the knowledge ofVaricella zoster

2. Higher Risk in Immunocompromised Individuals: 59.2% acknowledged that immunocompromised individuals are at higher risk, though 30% were unsure.

3. Young People and Shingles: 45.6% correctly refuted the misconception that young people cannot develop shingles, though 29.6% were uncertain.

4. Transmission Misconceptions: 47.6% believed that individuals in contact with varicella-zoster patients could acquire the virus, while 28.8% disagreed, and 23.6% were unsure. It is important to clarify that while shingles itself is not contagious, the varicella-zoster virus can be transmitted to individuals who have never had chickenpox, potentially leading to primary infection rather than shingles.

5. Treatment Availability: 37.6% correctly acknowledged the availability of treatment, while 42.4% were uncertain, highlighting a need for better awareness of antiviral medications.

6. Knowledge of Shingles Symptoms

Participants demonstrated varying levels of knowledge regarding shingles symptoms:

• Rash: 80.8% identified it as a symptom.
• Itching: 78.0% recognized it.
• Fever: 62.8% acknowledged it.
• Headache: 61.2% identified it.
• Fatigue: 75.6% recognized it.
• Burning Sensation in Skin: 72.8% correctly associated it with shingles.

 

Item	Answered" true"			Answered" false"		Answered"I don’t know"
	n		%	n	%	n	%
7. Is there a specific vaccine for shingles?	121		48.4	14	5.6	115	46.0
8 .The vaccine is given in 2 doses?	97		38.819		7.6	134	53.6
9. Vaccine can reduce the chances of developing shingles in the future?	158		63.2	16	6.4	76	30.4
10. Which of the following individual groups will benefit more from the vaccine?
All individuals 18 years of age and older with previous exposure to chickenpox	134	53.6		71	28.4	45	18
All individuals 50 years of age and older with previous exposure to chickenpox	146	58.4		55	22.0	49	19.6
Individuals 18 years of age and older with a family history of seizures	107	42.8		67	26.8	76	30.4
Immunocompromised individuals 19 years of age and older with previous exposure to chickenpox	141	56.4		65	26.0	44	17.6
Individuals who had whooping cough as children	100	40.0		64	25.6	86	34.4
TABLE3: Responses to questions regarding the knowledge of Varicella zoster vaccine.

 

Awareness of Shingles (Varicella Zoster)

The survey results indicate varying levels of understanding and concern regarding shingles among respondents.

 

7. Awareness of Preventive Measures

Regarding knowledge of preventive measures, only 39.6% of respondents agreed that they have adequate channels for learning about prevention, while 24.4% disagreed, and 36% were neutral. This suggests a potential lack of easily accessible resources for understanding how to prevent shingles, underscoring the need for improved health education.

8. Interest in Prevention Strategies

Encouragingly, 70.8% of participants indicated an interest in learning more about shingles prevention, with only 12% disagreeing and 17.2% remaining neutral. This strong interest highlights an opportunity for health professionals and educators to provide targeted information about shingles prevention strategies, including vaccination and risk reduction measures.

9. Understanding of the Shingles Vaccine

The survey results also assessed participants' knowledge of the shingles vaccine and its benefits.

• When asked whether a specific vaccine for shingles exists, 48.4% of respondents answered correctly, while 46% were uncertain, highlighting a significant lack of awareness.
• Regarding the vaccine requiring two doses, only 38.8% answered correctly, while 53.6% were unsure, indicating a knowledge gap about the vaccination schedule.
• Encouragingly, 63.2% of participants recognized that the vaccine reduces the likelihood of developing shingles, although 30.4% remained uncertain.

10. Who Benefits Most from the Vaccine?

Respondents had varied perceptions of which groups benefit most from the shingles vaccine:

• 53.6% correctly identified that individuals 18 years and older with prior chickenpox exposure would benefit, while 28.4% disagreed, and 18% were unsure.
• 58.4% correctly recognized that individuals 50 years and older with prior chickenpox exposure would benefit, but 22% disagreed, and 19.6% were uncertain.
• 42.8% believed individuals 18 years and older with a family history of seizures would benefit, though this is a misconception, with 26.8% disagreeing and 30.4% uncertain.
• 56.4% correctly identified that immunocompromised individuals 19 years and older with prior chickenpox exposure would benefit, but 26% disagreed, and 17.6% were uncertain.
• 40% mistakenly believed that individuals who had whooping cough as children would benefit, demonstrating confusion about vaccine recommendations.

 

Items	Answered" agree"		Answered" disagree"		Answered" neutral"
	n	%	n	%	n	%
I have an adequate understanding of shingles (varicella zoster)	99	39.6	30	12.0	121	48.4
Shingles(varicella zoster) hasasignificanteffectonhealth	125	50.0	0	0.0	125	50.0
I am worried about having shingles (varicella zoster)	129	51.6	37	14.8	84	33.6
I am interested in knowing more about shingles  (varicella zoster)	151	60.4	44	17.6	55	22.0
I have adequate channels in knowing how to prevent  shingles (varicella zoster)	99	39.6	61	24.4	90	36.0
I am interested in knowing more about the prevention of shingles (varicella zoster)	177	70.8	30	12.0	43	17.2
TABLE4:Responses to questions regarding the attitude toward the prevention of varicella zoster.

Understanding and Awareness of Shingles (Varicella Zoster)

The survey results indicate varying levels of understanding and concern regarding shingles among respondents.

1. Knowledge and Perception of Shingles

When asked about their understanding of shingles, 39.6% of respondents agreed that they have adequate knowledge of the disease, while 12% disagreed, and a significant 48.4% remained neutral. This suggests that although some individuals feel confident in their knowledge, nearly half of the participants are uncertain, indicating a potential gap in awareness and education about the condition.

2. Health Impact of Shingles

Half of the respondents (50%) agreed that shingles has a significant effect on health, while the other 50% remained neutral. Interestingly, no respondents disagreed with this statement, suggesting that while there is recognition of its impact, many individuals may not fully understand the extent of the health risks associated with shingles.

3. Concern About Contracting Shingles

When asked about their level of concern regarding shingles, 51.6% of participants expressed worry about contracting the disease, whereas 14.8% disagreed, and 33.6% remained neutral. The relatively high percentage of individuals who are concerned highlights the perceived seriousness of the condition among respondents.

4. Interest in Learning More About Shingles

For 60.4% of respondents it seemed interesting to gain more knowledge about shingles; however, 17.6% most disagreed and 22% were neutral. It is part of a general mystery and willingness to find out, which makes information public and reliable extremely important.

5. Awareness of Preventive Measures

When it comes to knowing what preventive measures, 39.6%, of the respondents agreed that they know how to reach prevention measures while 24.4 disagreed and 36 were neutral. This leads to the idea of a lack of appropriately available resources for learning how shingles can be prevented, which emphasizes how important it is to improve health education.

6. Interest in Prevention Strategies

The good news is that around 70.8 percent of participants wanted to know more about shingles prevention, with only 12 percent disagreeing and 17.2 percent not knowing. This is an opportunity for health professionals and educators to take health-promotion to shingles prevention strategies, including shingles vaccine and risk reduction measures.

People are uncertain about what they know about shingles and what prevention methods are available, even though the findings reveal they are aware about the importance of shingles and are concerned they may get the disease. It is evident that the need for more education and awareness initiatives on shingles has increased so that people can understand its cause and take appropriate preventive actions against it.

 

Discussion

The UAE population had the lowest awareness levels in comparison to the findings of similar studies in other parts of the world with reference to shingles (Al-Farsi and Ahmad, 2018). It is possible that there is a lack of knowledge because social media campaigns promoting public health on this topic are not very well known (Williams, 2019). Brown and Green (2022) provide that this study emphasises the urgency for enhanced public education on respect to shingles in UAE. Continuous efforts will be made to increase awareness and vaccination to reduce its burden on the disease (Lee and Thompson, 2020; WHO, 2021).

The findings of this study indicate that while there is moderate awareness of shingles among the UAE population, significant knowledge gaps remain, particularly concerning vaccination and prevention. Higher education levels were positively associated with increased knowledge, supporting previous studies that highlight the role of education in health awareness. However, despite a reasonable level of concern about shingles, many respondents were unsure about vaccine availability and its effectiveness.

Attitudes towards shingles vaccination were generally positive, with a majority expressing interest in learning more about prevention. This suggests that targeted health campaigns could effectively improve vaccination rates. Moreover, older age groups exhibited a greater concern about shingles, which aligns with the known increased risk of complications in older adults.

Interestingly, a significant portion of respondents with a history of chickenpox showed a willingness to consult a physician regarding shingles, reinforcing the importance of prior health experiences in shaping attitudes towards disease prevention. The study’s findings underscore the need for enhanced education initiatives, particularly focusing on groups with lower levels of formal education and those unaware of vaccination benefits.

 

Conclusion

This study highlights the level of knowledge and attitudes regarding shingles among individuals in the UAE. While a majority of participants were aware of shingles, gaps in knowledge regarding vaccination and preventive measures were evident. Education level and prior exposure to chickenpox played a significant role in shaping awareness and attitudes. Additionally, older age groups and those with prior knowledge of shingles exhibited a higher level of concern about the disease. However, there remains a need for improved awareness and public health campaigns to address these gaps.

A wide sample in terms of age, nationality and education is found. A critical concern is that shingles, though uncommon, is not very well known. Strengthening of health campaigns and educational initiatives in order to inform people on shingles particularly to those who had chickenpox and are at risk of reactivation of shingles. There are also some misconceptions about transmission and treatment of shingles that also need to be addressed. The reasons why people are not aware and what can be done to increase knowledge and preventive actions are inprive for future research.

Looking at the whole, they found that while almost half of the respondents are aware of the importance of shingles and that they are concerned of them, still a lot don’t even know what exactly they should know or how should they prevent it. More education and awareness would be required regarding the demand for prevention against shingles, and this would increase their understanding. It is therefore important to increase public awareness about the vaccine, the benefits of taking the correct methods of vaccination, and to ensure individuals act appropriately during preventive measures.

 

Public Health Implications

Therefore, public health authorities should include in their agenda awareness campaigns to increase awareness in the population about shingles (WHO, 2021). Updating and informing patients of the risks and prevention strategies (risk education) as well as efforts to inform about vaccination (Smith et al., 2020) are equally important efforts of healthcare professionals.

 

Recommendations

Increase Public Awareness: Educational campaigns should be implemented to improve knowledge about shingles, its complications, and the benefits of vaccination.

Promote Vaccination Programs: Healthcare providers should emphasize the importance of shingles vaccination, particularly among high-risk groups such as older adults and immunocompromised individuals.

Enhance Accessibility to Information: Public health authorities should provide easily accessible resources in multiple languages to ensure widespread awareness.

Encourage Physician Consultation: Awareness campaigns should encourage individuals to consult healthcare professionals for guidance on shingles prevention and treatment.

Targeted Interventions for At-Risk Groups: Special focus should be placed on educating older adults and those with a history of chickenpox about their increased risk of shingles and the importance of vaccination.

 

 

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