Introduction

Zika virus disease is an acute viral infection caused by the Zika virus, an arbovirus of the genus Flavivirus and the family Flaviviridae.

The disease is most commonly transmitted through the bite of infected mosquitoes of the genus Aedes, which are active mainly during the day and are most prevalent in tropical and subtropical regions. However, transmission is also possible through sexual contact, vertically from mother to fetus during pregnancy, as well as through blood transfusion.

The virus was first identified in Uganda in 1947 in a rhesus macaque monkey, after which infections were also confirmed in other African countries in the 1950s. From the 1960s to the 1980s, sporadic human infections were detected across Africa and Asia, and since 2007, outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia, and the Pacific.

Cases of Zika virus disease have declined globally since 2017, but transmission continues at low levels in several countries in the Americas and in some countries in Asia and Africa, where sporadic outbreaks have also been documented.

Clinical picture

The incubation period of the disease usually lasts 3–14 days. The clinical presentation is generally mild and is characterized by symptoms that typically last 2–7 days, although the majority of infected persons (about 80%) do not develop symptoms. The most common symptoms include:

·         rash

·         elevated body temperature

·         conjunctivitis

·         headache

·         myalgia and arthralgia

Zika virus infection during pregnancy can result in babies born with microcephaly and other congenital malformations, as well as premature birth and miscarriage. It may also be associated with Guillain-Barré syndrome, neuropathy, and myelitis in adults and children, which contributes to the public health significance of this disease. Congenital malformations may occur in both symptomatic and asymptomatic infections.

These symptoms are common to other arboviral and non-arboviral diseases; therefore, diagnosis of Zika virus infection requires laboratory confirmation.

Treatment is symptomatic; there is no specific medication or vaccine for prevention of the disease.

Information on the Zika infection case

On 17.06.2026, the Virology Department of the Institute of Public Health received information about a confirmed positive finding of Zika virus infection.

The patient was contacted by the responsible epidemiologist, and appropriate preventive measures were recommended.

Epidemiological data

According to the available epidemiological data, the infected person stayed in the Maldives from 20–28.05.2026. During the stay, the patient reported being bitten by a mosquito. Immediately after returning, the patient sought medical examination at the University Clinic for Infectious Diseases and Febrile Conditions, where dengue was initially suspected.

Clinical picture

The first signs of the disease appeared on 24.05.2026 with fever, body aches—muscle and joint pain—and a mild elevated temperature. Four days later, a fine, diffuse rash appeared.

The patient was examined at the clinic, and laboratory tests for dengue, Zika, and chikungunya were performed at the Virology Department of the Institute of Public Health. According to microbiological results, both serological and molecular tests for Zika were positive.

The patient was not hospitalized, was sent for home care, and is currently in good general condition.

Risk assessment

This is the first registered case of Zika virus infection in the Republic of North Macedonia.

Although it is an imported case, due to intensive international travel and increasing trends of travel to tropical tourist destinations such as the Maldives, Thailand, Indonesia, Brazil, the Caribbean region, and other areas with documented Zika virus circulation, there is a realistic possibility of additional imported cases.

An additional risk factor is the widespread presence of Aedes albopictus (Asian tiger mosquito) in several European countries, which is a potential vector for Zika virus transmission.

The European Centre for Disease Prevention and Control (ECDC) continuously registers travel-associated Zika cases in individuals infected while staying in endemic areas. The ECDC specifically monitors these “travel-associated” cases, and the WHO indicates that the presence of Aedes albopictus in parts of Europe creates a potential for local transmission if the virus is introduced by an infected traveler.

There is a possibility of further reporting of new cases during the mosquito activity season among people traveling to affected regions, and the risk for these individuals is assessed as low to medium.

The risk to the population of North Macedonia is currently assessed as low.

The risk can be significantly reduced by implementing recommended preventive measures against mosquito bites and adhering to preventive guidance.

Measures taken:

·         An epidemiological questionnaire was prepared for the infected person.

·         A report of an isolated/otherwise confirmed infectious disease agent was submitted.

·         Disinsection was carried out epidemiologically in the area surrounding the patient’s residence.

·         Advice was given regarding prevention of sexual transmission of the disease.

Recommended measures:

1.       Education of the population about the disease, transmission routes, and prevention through appropriate educational materials.

2.       Notification of general practitioners and infectious disease specialists about the occurrence of the disease, so it is included in differential diagnosis for any febrile illness with rash in individuals who have traveled to high-risk areas.

3.       Timely reporting of suspected and confirmed Zika virus infections by diagnosing physicians to competent health authorities.

4.       Planned implementation of disinsection activities (according to municipal plans), as well as additional disinsection based on epidemiological indications.

5.       Pre-travel consultation for tropical or subtropical destinations with epidemiological services of public health centers for information and preventive advice regarding vector-borne diseases in the destination region.

6.       Recommendations for protection against mosquito bites:

·         use of repellents outdoors

·         wearing long-sleeved clothing and long pants

·         installation of protective screens on windows and doors

·         avoiding unnecessary outdoor exposure at dawn and dusk when mosquito activity is highest

·         preventing stagnant water accumulation (yards, barrels, tires, toys, etc.)

Citizens who develop symptoms after a mosquito bite, especially fever, headache, rash, or neurological symptoms—particularly if they have returned from travel to tropical or subtropical destinations—should seek medical attention immediately.

The Department of Epidemiology of Infectious Diseases at the Institute of Public Health is in communication with the competent Centre for Public Health and is monitoring the situation. Any changes will be reported accordingly.