During the 20th week of 2019, (13.05.2019-19.05.2019) the Republic of North Macedonia registered 30 influenza cases/flu-like diseases(I=1,5/100.000). Compared with the number of registered cases in the last week, are decreased for 48,3% (n=58)
The incidence this week is below the weekly limit of seasonal (low) activity of the influenza virus (Chart 1).
Over the past week, there has been no registered deaths associated with influenza. This week, the virological laboratory of the IPH has received 8 influenza testing materials, all negative for the presence of influenza.
Chart 1. Levels of intensity and weekly distribution of influenza / influenza-like illness patients according to the expected epidemic curve 2010-2018, season 2017/2018 and season 2018/2019
This week most of the cases have been registered in a group 15-64 years (n=14; 46.7%)and the highest incidence is registered in children aged 0-4, I=9.5/100 000.
This week were reported cases from 8 reporting units. Most of the cases have been registered in Skopje (n=10)and the highest incidence is registered in Gostivar, I=7.5 /100 000. (chart 1).
In the 2018/2019 season, the total number of influenza cases is 21531 (I=1040.6/100.000).
Compared with the same period last season , there is a decrease in the total number of reported cases by 10.1%, and in relation to the model for the last 8 seasons (n=25958) a decrease of 17.1% .
Cumulatively this season, most of the cases have been reported from Skopje (n=3.723; 17,3%), Strumica (n=2.492; 11,6%), Kavadarci (n=1.898; 8,8%), Gostivar (n=1.763; 8,2%) and Prilep (n=1.577; 7,3%)
The highest cumulative incidence of 4410.5/100.000 habitants was registered in Kavadarci and also in Strumica(2631.0/100,000). and also high incidence over 1500,0/100 000h. was registered in Debar, Resen, Sveti Nikole, Kratovo, Prilep(chart2)
Chart 2. Distribution of cases of seasonal influenza per CPH / RO and incidence of 100,000 inhabitants, season 2018/2019
Over the season, have been registered 29 deaths associated with influenza. 13 people from Skopje. In 21 people (72,4%), pre-chronic disease has been identified, ie co-morbidity.The age of the deceased ranges from 5 months to 86 years.
The following chart shows the cumulative flu-influenza / flu-like illness for the 2018/2019 season by CPH / RO. The chart shows that in terms of the incidence of 100,000 inhabitants, the influenza season was the most intense in the territory of Kavadarci, and with somewhat lower intensity in several CPH / RO from the eastern part of the country (Strumica, Kratovo, Sv. Nikole) and Debar in the western part of Macedonia. (chart)
Chart. Cumulative influenza / flu-like illness of 100,000 inhabitants per CPH / PE, Republic of North Macedonia, season 2018-2019
Regarding the distribution of the diseased by age groups, the cumulative number of cases was reported in the age group of 15-64 years – 13703 cases (63.6%), and the highest cumulative incidence of 939.0 / 100.000 was registered in 0-4 years with 2371 cases (Chart 3, Chart 4).
Chart 3. Distribution of cases of seasonal flu by age, season 2018/2019
Chart 4. Weekly distribution of seasonal influenza cases by age group – incidence of 100,000 inhabitants, season 2018/2019
Distribution of seasonal flu patients by month (Chart 5)
The season, according to the MEM model, was registered in the 5th week of 2019, and from the 13th week the off-season level of activity of the influenza virus was registered again. The incidence of registered cases of influenza / influenza-like illness peaked in the 8th week of 2019, a few weeks later than expected. The analysis of the number of seasonal flu cases by months indicates a gradual increase in the number of patients in January and a peak in February.
From the total number, in 2018, 1,218 persons or 5.7% were registered. The remaining 94.3% or 20,313 persons were registered in 2019.
Chart 5. Distribution of cases of seasonal flu by month, season 2018/2019
During the 2018/19 season, a total of 29 influenza-related deaths were registered.
The deceased are aged 5 to 86 years.
The largest number of deceased persons are residents of the area of CPH Skopje (n = 13). The others are: 4 from CPH Ohrid, three from KP Kavadarci, two from Delchevo, Kicevo and Tetovo and one from Kriva Palanka, Resen and Valandovo.
From the total number of influenza-related deaths, 21 persons (72.4%) found comorbidity. The most common comorbidities are diabetes (in 8 people) and hypertension (in 8 people), cardiomyopathy (in 4 people) and COPD (in 4 people).
In terms of laboratory diagnosis, with the RT-PCR method in the Virology and Molecular Diagnostics Laboratory in the IPH, in most of the deaths, Influenza A (H1) pdm-20 has been proven, 4 people have proven Influenza A non subtyped and in one person Influenza A (H3). With pneumoslide in the laboratory in CPH Bitola, one person has proven infection with Influenza A and in one person Influenza B virus.
From the beginning of the season, the laboratory for virology of IPH has received 861 samples, materials for laboratory diagnostics, of which 433 (50.3%) are positive for the presence of influenza virus, all are Influenza A: 324 (74.8%) are Influenza A(H1N1)pdm, 57 (13.2%) are Influenza A(H3), аnd 52 (12.0%) are Influenza А non-subtyped(chart 5)
Chart 6. Weekly distribution of number and percentage of Influenza positive samples 2018/2019
From the routine surveillance samples (n = 222), 129 (58.1%) were tested positive for the influenza virus. From these, 104 were confirmed as Influenza A (H1) pdm, 13 were Influenza A (H3), and 12 were untyped Influenza A viruses.
From the samples of sentinel surveillance (n = 639), 47.6% were positive for the presence of the influenza virus. 220 were confirmed as Influenza A (H1) pdm, 44 were Influenza A (H3), and 40 were untyped Influenza A viruses. (Table 2, Chart 6)
Table 2. Distribution of the number and percentage of positive materials from routine and sentinel supervision by origin and total, R. N. Macedonia, 2018/2019
| Type and subtype of the virus | Origin | Season 2018/19 | ||
| routine | sentinel | number | % | |
| Influenza A | 129 | 304 | 433 | 100% |
| Influenza A(H1)pdm | 104 | 220 | 324 | 74,8% |
| Influenza A(H3) | 13 | 44 | 57 | 13,2% |
| Influenza А non sub-typed | 12 | 40 | 52 | 12,0% |
Chart 6. Distribution number and percentage of positive materials from routine and sentinel supervision by type and weeks, R. N. Macedonia, 2018/2019
Vaccination against seasonal influenza is the most effective protection against this disease, therefore the Public Health Institute recommends vaccination of the entire population, especially for people belonging to risk groups (according to WHO recommendations):
- Pregnant women at any stage of pregnancy
- children aged 6 months to 5 years
- elderly people aged 65 years and over,
- People with chronic diseases and conditions of weaken immunity
- Health workers.
For the first time, since this season of influenza, Macedonia launched a free influenza vaccination for a particular category of population. For that purpose, the Ministry of Health has purchased 28,000 doses for people over 65 years of age with an average, under-average pension or no income. Additional 19387 doses were procured by the Public Health Centers as commercial vaccines for the rest of the population.
Vaccination with free and commercial influenza vaccines is carried out by CPH / RO, as well as the previous seasons, and for the first time this season, the appointment for free vaccines is through a family doctor in the My Term system.
According to the data from the Department of E-health, from the beginning of the vaccination on 05.11.2018, and as of the closing of this report, a total of 20178 persons (70.8%)were vaccinated. (persons over 65 years with average, under-average pension and no income, health workers and other population according to the guidelines from the Ministry of Health / Commission for Infectious Diseases).
In terms of commercial vaccines, according to available data from CPH / RO, 19355 people were vaccinated. The largest number of vaccinated are over the age of 65 years – 10977 or 56.7%, aged 30-64 years – 7377 or 38.1%, while at the age of 5-29 are 196 or 1.0 %. 4 children under the age of 5 were vaccinated. From the category of health workers, 801 persons or 4.1% were vaccinated. No vaccinated pregnant women. From the total number of vaccinated patients, 14114 persons or 72.9% have a history of chronic diseases. Additionally, 3 vaccines are incorrectly applied.
Table 3 presents the number of vaccinated individuals per week, from which it can be seen that 96.2% appplied a vaccine during the first 5 weeks of starting vaccination.
Table 3. Number of vaccinated against influenza by weeks (cumulative), season 2018-2019
Табела 3. Број на вакцинирани против грип по недели (збирно), сезона 2018-2019
| Week, season 2018/2019 | Number of vaccinated persons | % |
| 45 недела | 21.916 | 55,4% |
| 46 недела | 9.127 | 23,1% |
| 47-49 недела | 6.857 | 17,3% |
| 50-52 недела | 1.350 | 3,5% |
| 1-20 недела | 286 | 0,7% |
| Total | 39.536 |
According to the data, in the Neuromedica Clinic, 50 people were vaccinated from a total of 200 procured vaccines (25.0%). The majority of the vaccinated (42.0%) are in the age group of 30-64 years. One pregnant women is vaccinated and 11 health workers. From the total number of vaccinated patients in PHI Neuromedica, 38.0% have a history of chronic disease.
EUROPE
According to records presented in Flu News Europe, the activity of influenza virus in Europe is the following: All countries reported a low intensity of the influenza virus.
During the 2018/2019 season, the two subtypes of influenza A circulate, with some countries registering co-circulation, while other countries report the dominance of A (H1N1) pdm09 or the A (H3N2) subtype.
From the beginning of the 40th week, over 99% of influenza A viruses detected by SARI (severe acute respiratory infection) cases were subtyped, and 79% of them were A (H1N1) pdm09.
In general, current influenza vaccines tend to act better against influenza A (H1N1) pdm09 and influenza virus B than against influenza A (H3N2).
For the 2019-2020 season of the northern hemisphere, WHO recommends a four-valent vaccine containing:
- A / Brisbane / 02/2018 (H1N1) pdm09-like virus;
- A / Kansas / 14/2017 (H3N2) -like virus;
- B / Colorado / 06/2017-like virus (B / Victoria / 2/87 lineage);
- B / Phuket / 3073/2013-like virus (B / Yamagata / 16/88 lineage).
