During the 3rd  week of 2020 (from 13.01–19.01.2020), 1100 (I = 53.2/ 100,000) cases of influenza / flu-like illnesses were reported in the Republic of North Macedonia.

This week, 40 materials were available for laboratory testing of influenza in the IPH laboratory for virology. From the tested materials, 20 (50.0%) were positive for the presence of influenza virus – 12 were detected type A (5 A / H1pdm, 4 A / H3 and 3 non typed) and 8 were influenza type B (6 Victoria). and 2 Underemined line ).

Compared to the number of reported cases registered this week to the 3rd  week of last season (n = 535) is increased by 2 times and compared to the 3rd week of the typical epidemic curve (modeled from the last 9 seasons) ( n = 1623) is registered an decrease of 32.2% (Chart 1).
The reported incidence is below the weekly limit of seasonal activity of the influenza virus (I = 36.4 / 100,000).

Influenza activity is below the seasonal level, according to the MEM model for determining the intensity of seasonal influenza activity (Figure 1). (chart 1).

Chart 1. Intensity levels and weekly distribution of influenza / influenza-like illness by expected epidemic curve 2010-2019, season 2018/2019 and 2019/2020


Regarding the distribution of the diseases by age groups, the highest number of cases was reported in the age group that covers the largest part of the population (15-64 years) – 689 cases (62.6%) and the highest incidence (106.7 / 100,000) is registered in children aged 0-4. (chart 2)


This week, 23 reporting units reported cases. Most of the cases were reported from Strumica (n = 218). The highest weekly incidence (I = 569.3 / 100,000) is registered in Debar, with 158 cases.

13 reporting units reported very low activity during this week, 7 reported seasonal (low), 2 – Strumica and Radovis – average and 1 – Debar registered very high activity of the influenza virus ( Image 1).

Chart 1. Level of influenza activity according to the incidence of 100,000 inhabitants, 3 weeks 2020



Cumulative data

In the 2019/2020 season, the total number of influenza cases was 2718 (I = 131.4 / 100,000).

Compared to the same period last season (n = 2327), there is a increase in the total number of reported cases by 16.8%, while compared to the model for the last 9 seasons (n ​​= 4909) there is a decrease of 44.6% .

Cumulatively this season, from cases have been reported from 26 reporting units,

The highest number of infected persons  are registered (n ​​= 99; 27,5%) in Strumica (n = 555), Gostivar (n = 501) and Skopje (n = 344) (chart 3)

The highest cumulative incidence (I = 1055.7 / 100,000) were registered in Debar, with 293 cases.
Cumulative incidence of over 250.0 / 100,000 inhabitants is registered in Sveti Nikole, Strumica, Gostivar and Radovis (chart 3).

Chart 3. Distribution of cases of seasonal influenza by CPH / RO and incidence per 100,000 population, season 2019/2020


Regarding the distribution of the diseases by age groups, the highest number of cases was reported in the age group that covers the largest part of the population (15-64 years) – 1678 cases (61.8%) and the highest incidence (277.1 / 100,000) is registered in children aged 0-4. (chart 4)


Chart 4. Distribution of seasonal influenza cases by month, season 2019/2020


Since the start of the 2019/2020 season, a total of 146 materials from health facilities – from outpatient and hospital treated patients to regular and sentinel surveillance – have been received at the IPH Laboratory for Virology, of which 26 (17.8%) are positive of the influenza virus (chart 6).From the positive, 18 (69.2%) are Influenza A, while 8 (30.8%) are Influenza B. According to the Influenza A subtype, 8 (44.4%) were A / H1pdm, 5 (27.8%) A / H3, and 5 were non-subtyped. According to Influenza B line, 6 (75.0%) are B / Victoria and 2 are indefinite.

Chart 6. Weekly and cumulative distribution of number and percentage of positive samples of influenza 2019/2020



Vaccination against seasonal influenza is the most effective protection against this disease, which is why the Institute of Public Health recommends vaccination of the whole population, especially for people who are part of the so-called “influenza.” risk groups (according to WHO recommendations):

Elderly people (over 65 years)•       Pregnant women• • Health workers • Children aged 6-59 months.

According to data from the EHS, since the start of the vaccination on 15.11.2018, and as of the close of this report, a total of 27122 people from the at-risk population have been vaccinated. .

Regarding to commercial vaccines, as of 19/01/2020, and according to available data from the PH / RO reports, 14,627 persons have been vaccinated. Most of those vaccinated are over 65 years of age – 7,262 or 49.6%, 30-64 years old – 6,487 or 44.3%, while aged 5-29 are 461 or 3.2 %. 10 children younger than 5 years of age are vaccinated. From the category of health care workers, 404 persons or 2.8% were vaccinated. Three pregnant women have been vaccinated. From the total number of vaccinated, 7,891 (53.9%) have a history of chronic illness.


All interested people should contact the nearest Public Health Center or Regional Unit for more detailed information on seasonal influenza vaccination.

Vaccination with free and commercial vaccines against influenza is administered in PHC / RU, each for its own area. For the territory of Skopje, besides PHC Skopje, this season the vaccination will be carried out in the Polyclinics Bucharest, Gjorce Petrov and Chair. The appointment for the free vaccines will take place at the family doctor, through the My Termin electronic system.
An additional 20800 doses of vaccine have been purchased from the Centers for Public Health as vaccines for the rest of the population not included in the above groups and can be obtained for a certain financial fee .



According to a report by Flu News Europe released in week 2 of 2020, influenza virus activity is increasing.

In the reporting countries, the reported intensity of the activity of the virus is from low to high, and most of the countries are reporting widespread activity.

Detection of influenza virus in sentinel system samples is above 10% by week 47 of 2019. In most countries, the Influenza A virus is predominant, although there are countries dominated by Influenza B or co-circulation of both viruses.

During the week 2, the percentage of positive sentinel surveillance patients was 39.7%. Since the beginning of the season sentinel surveillance, 21.3% of tested positive for the presence of influenza viruses:

  • Influenza A – 253(67,1%):
    • A(H1N1)pdm09 – 543
    • A(H3N2) – 606
    • А non subtyped – 104
  • Influenza B – 593(32,9%):
    • Victoria lineage – 397
    • Yamagata lineage – 9
    • Undetermined line – 187