In Macedonia, West Nile fever infections continued to be detected during the second half of September. According to data from the Institute of Public Health, as of September 22, 70 cases had been recorded, of which 65 were confirmed and five were probable. In the week from September 16 to 22 alone, five new cases were reported: three in Skopje, one in Veles and one in Tetova. Of all those infected, 63 are residents of Skopje, while the rest come from Veles, Kumanovo, Sveti Nikole, Kavadarci and Tetova.
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The new geographical distribution once again highlights the Skopje region. According to the possible municipality of exposure, the largest number of cases is linked to Kisela Voda, with 15, and Gazi Baba, with 14. They are followed by Butel with seven cases, Aerodrom with five and Ilinden with four. Zelenikovo and Studenicani have three cases each, while infections have also been recorded in Centar, Petrovec, Sopishte, Saraj, Aracinovo and Chair. Outside the Skopje region, the areas mentioned are Veles, Chaska, Kavadarci, Sveti Nikole, Kumanovo, Dolneni and, in the latest report, Tetova.
However, these locations should not be interpreted as exact addresses where patients were infected. The Institute of Public Health stresses that this refers to a “possible municipality of exposure”, determined through an epidemiological survey, the incubation period and the patient’s movements. This is an indirect indicator of possible local circulation of the virus, not a laboratory-confirmed place of infection.
Of the 70 registered patients, 57 are over 60 years old. The average age of all patients is 66.5, while 52 of them are men.
So far, nine patients have died. All were men with the neuroinvasive form of the disease, aged between 62 and 83, with an average age of 71.1. Eight of the nine had underlying health conditions. Eight of the deceased were from Skopje and one from Kumanovo.
Of the 70 recorded cases, 68 developed the neuroinvasive form and were hospitalized. Of these, 50 patients have been discharged, nine remain under treatment and nine have died.
However, this percentage does not mean that almost all people infected with West Nile virus develop severe neurological disease. European and US health authorities estimate that around 80 percent of infections are asymptomatic, around 20 percent cause mild West Nile fever, and fewer than one percent progress to the neuroinvasive form.
The high proportion of severe cases in Macedonian statistics is likely also linked to the way patients are detected. The Institute of Public Health recommends laboratory testing especially for suspected cases of encephalitis, aseptic meningitis, acute flaccid paralysis or fever of unknown origin. This means that the system more readily records patients who are hospitalized, while a large proportion of mild and asymptomatic infections never appears in the official figures.
The ECDC described the situation in Macedonia as an unprecedented West Nile virus season at the beginning of September, particularly in the Skopje region. At the European level, by September 17, 1,482 locally acquired infections had been reported in 16 countries, and Macedonia had 66 cases in that European region. Five days later, the national total had already reached 70.
The Institute of Public Health says that the strongest spread in Macedonia occurred in July and August, but cases continue to emerge in September. On August 11, the institute had reported an outbreak in Kisela Voda, Gazi Baba, Aerodrom and Butel, while it now assesses that the concentration of cases in the Skopje region indicates active local circulation of the virus.
An additional signal comes from animal surveillance. So far, the virus has been laboratory-confirmed in two dead crows found in Skopje and one in Resen. The Food and Veterinary Agency has intensified bird surveillance throughout the country since the end of August.
West Nile virus is most commonly transmitted to humans through the bite of an infected mosquito. The Institute of Public Health recommends removing standing water around homes, installing window screens, wearing clothing that covers most of the body and using repellents according to the product instructions. Mosquitoes are particularly active at dawn and dusk.
Some infected people may experience fever, headaches, muscle and joint pain, fatigue, vomiting or a rash. The Institute of Public Health recommends seeking medical help if symptoms appear, especially if neurological signs develop.
