State of flu in R. of Macedonia

Category: Content Published on Wednesday, 30 July 2014

Season 2013/2014

(Fifth week, to 02.02.2014)

During the fifth week of 2014 (from 27.01.2014-02.02.2014) in Republic of Macedonia were registered 2.350 (MB 11,4/10.000) new diseased in the group application for flu diseased, which in  relation to the last week is increasing the number of registered cases for 12,4%.

The diseased were registered from 28 reporting units (from total 31) (Diagram 1).

In comparison with the diseased from the 5th week from the last season (2.190) are noticed increase for 7,3% in relation to the epidemic threshold (the average number of diseased for increase for this same week in past 10 years period, which is 1.738) is registered increase of 35,2 %.

Diagram 1. The average number of cases of flu on weekly level, in the period 2003/2004-2012/2013, in comparison with the number of registered cases of weeks in the season 2012/2013 and 2013/2014

The total number of diseased form flu in the Republic from the start of the season 2013/2014 (40th week, 2013) concluded with the 5th week of 2014, is 7.778 (MB 37,8/10.000). In this period were registered two cases of dead, associated with infection of the flu virus.

In comparison with the same period last year (5.664 diseased), there was increase of the total number of registered cases for 37, 3 %, and in relation with the average of period of 10 years (6.566) has been registered increase of 18, 5 %. Diseased people for the whole season were registered in 30 from 31 reporting units, but in 4 units the number of registered diseased people was less than 10. Distribution of diseased from flu of months presented on diagram 2, points out on that in month January was registered the biggest number of cases with symptoms of flu-6.801 or 87,4% from the total number of diseased in the whole season 2013/2014.

In December, 606 cases or 7, 8 % were registered. 

Diagram 2.The number of diseased from flu in R.M in the season 2013/2014, by month.


The biggest number of diseased this season were registered on the territory of CPH Veles/RU Kavadarci-1.360 and CPH Skopje-1.154 diseased, the biggest MB (315,2/10.000) was registered in RU Kavadarci (Diagram 3).

Diagram 3. The number of diseased and the morbidity of flu in RM in the season 2013/2014, by CPH/ RU


The number of diseased and morbidity to age groups, in the season 2013/2014 is presented on table 1.The biggest number of diseased were registered in the age group which covers the biggest part of the population ( from 15-64 years) with 5.083 cases (65,4%), biggest MB  (75,2/10.000) was  registered among the youngest- children from 4 years.


Table 1.The number of diseased and MB, by age group.

Age group

0-4 years

5-14 years

15-64 years

65+ years


Number of diseased












During the 5th week of 2014, the virus laboratory of IPH RM received 11 materials for testing flu, from which 6 were positive and so: 3 were positive on the virus of influenza, A/H3N2, 2 were non typified influenza A virus 1 of the influenza virus A/H1N1 pdm09. From the start of the season 2013/2014, in this lab has been received total 73 human materials from health institutions in ambulance and medical treated patients, from which 35 or 44,9 % were positive on the virus influenza. From the positive, 30 materials were confirmed as influenza A (85,7%), and in 5 is witnessed presence of influenza B virus (14,3%). From influenza A positive, 7 or 23,3% are confirmed as  influenza A/H1N1 pdm 09, 15 materials are positive on influenza A/H3N2 (50 %), and 8 are no typified influenza A viruses (26,7 %). The number of registered cases of flu/diseases similar to flu in Macedonia keeps the trend in increase, with decrease the intensity of the increase and this week, as the previous. It is expected this trend in increase of the activity on the virus influenza to sustain and in the following weeks, with variations of the intensity.

In the circulation there are two subtypes of the influenza A and influenza B virus with domination of the virus influenza A/H3N2.


In the report for the movement of the virus in the season 2013/2014 in Europe, according to the electronic weekly paper of WHO-Euro flu for the 4th week, it was declared that activities of the virus flu in the last few weeks in the European region- mainly in the southern countries increased slowly, but steadily.

In the other countries, the activity is lower in comparison with the same period from the last season. Even, in the fourth week all countries registered increasing trend of the activities. From the start of the season, influenza A 9 was the most dominant type of the region. The number of lab confirmed, hospitalized cases are increased in the last few weeks in the Southern and Western European countries, and 87 % from the cases in the 4th week are caused from A (H1N1)pdm09.

During the 4th week 10.749 exemplars from diseased people were tested similar to the flu (ILI), acute respiratory infections (ARI) and heavy acute infections (SARI). From them, 1.568 or 15 % were positive on flu, and from them 96 % were positive on influenza A, while only 4 % on influenza B. From the start of the season (40 weeks/2013), has been detected and typified 7.969 exemplars of flu. From them, 94 % are typified as influenza A and 6 % as influenza B.                    From influenza A are typified findings, 5.473 are sub typified –from them 3.076 (56%) are A(H1N1)pdm09 and 2.397 (44%) are A(H3N2). Sub typified are 54 influenza B viruses and from them, 50 (93%) are B/Yamagata and 4 (7%) are B/Victoria. Till the end of 4th week, 17 countries declared dominant influenza virus (influenza A) for this season, while from the countries which give data from subtypification- Ireland, Slovenia, Macedonia and Turkey declared that dominant type is A(H3N2): Bulgaria, Greece. Latvia, Norway, Spain and United Kingdom (Scotland)- A(H3N1)pdm09, and France, Italy, Russia and Switzerland declared co domination among these two kinds. During the 4th week of 2014, more European countries declared low intensity of activity of the influenza virus, but increasing trend. Considering the geographical expansibility, mainly is sporadic, except in Bulgaria, Greece, Spain and United Kingdom (England) where is declared broad expansibility. Rates of ILI and ARI continued to increase in the third week, but still are under national epidemiological thresholds in 17 countries which established that thresholds, except Albania, Switzerland and Israel.
 The number of registered hospitalizations due to heavy acute respiratory infections (SARI) inconsiderably was decreased in the last week. The biggest number of hospitalized cases belongs to the age group of 0-4 years.

Sector for control and prevention of infectious diseases

Institute for Public Health



The vulnerable groups of population which are exposed on increased risk of possible health consequences:

  • The elderly people-older people have bigger risk to obtain consequences on their health as a result of the low external temperature due to their slower metabolism in comparison with the younger as their mobility is decreased. Especially under risk are the elderly people who live alone, who are immovable, eat inadequately, take medicines which cause for obstructed thermal regulation.
  • New born babies and children- the new born babies are under increased risk of extreme low temperatures and could faster develop hypothermia  as a result of the small dimension of their body ( they have different proportion of the surface part of the body and mass than adults) and bigger lost of warmth, as well as smaller ability for warmth production. The children have smaller muscle mass and among them decrease of body temperature can appear very fast than among adults in condition of same outside temperature. The respiratory system among children is more sensitive of the influence of the external temperature and among them the diseases of the respiratory system are more common. The children who have associated diseases as asthma are under increased risk of formation of consequences of the cold weather.
  • Socially threatened people who couldn’t allow adequate heating in their home (about 75 % of these people live alone, without anyone) or people who are exposed on low external temperature as homeless, or people who live in inadequate housing without isolation and heating, poor people.
  • Workers who work outside-workers with particular vocation which work is the outside environment for example construction, forestry and etc, are under great risk of health consequences as a result of the extreme low temperature.
  • People with chronicle diseases or people who use particular medicines or overuse of alcohol-medical state which can cause hypothermia with endocrine diseases for example hyperthyroidism, hyperputuirism, hyperadrenalism some head injuries, diabetes (especially when there is a hypoglycemia). The people who have physical disability from every reason (fracture or bodily disability in their development) due to immovability are also under increased risk for health consequences. The usage of some medicines for example barbiturates and phenothyazid  and etc
  • People with cardiovascular diseases-the cold weather increases the blood pressure-increased blood pressure increases the risk of presence of heart and brain strokes
  • People with respiratory diseases- the cold weather decreases the resistance to respiratory infections, decreases the function of the lungs and can activate the bronchial constriction of asthma.


For protection of the population health from cold waves and cold weather.

In the winter period:

  • Vaccination on time against seasonal flu (especially for people above 60 and chronicle diseased people).
  • Regularly taking the prescribed therapy and consultation with your primary care physician
  • Drink hot drinks.
  • Eat adequately because that maintains the body temperature.
  • Avoid alcohol because increase the risk of hyperthermia.
  • In case of cold and breathing difficulties, call your primary care physician.
  • Check the weather and the weather forecast and choose adequate clothes.


In case of extreme low temperature.

  • Avoid physical activity outside.
  • Use warm, multilayer clothes and adequate shoes for snow and ice.
  • Be careful on slippery surfaces.
  • Think about buying medicines and groceries earlier, to be delivered or ask a friend or neighbor for help.
  • Avoid going out except when it is necessary.
  • Be active and walk in closed rooms, as much you can.
  • Check the heating at home. At least one room should fulfill the recommended room temperatures (18-21°C).
  • If you have a chance to help to family members, neighbors or friends who are part of the population risky group (elderly people or the one with lung diseases). If you notice a person with risk of cold weather (homeless people) call the free number 15505.

Information for the vulnerable population groups

  • Elderly people have need of warmer clothes because they produce less warmth for the bodies.
  • Babies are subject to cooling, because of that we need to check if there are warm (hands and feet should be warm).
  • In case you have heart and lung health state, avoid the hard exercises on cold temperature and dress suitably (protect your head, hands and feet). Take the medicines earlier, if you use inhalator, inhale of the same before you go outside.
  • In case of diabetes, your hands and feet can be easily hurt or during extreme conditions, to suffer from freezing, so be careful to be warm.
  • If you have arthritis, you can come to conclusion that cold can worsen the symptoms. It will help if you warm the injured ankles and maybe you can adapt your medicaments.
  • Pay attention on the people who live alone.
  • Housing and heating during cold weather.
  • If there is a cut off of heating during extreme low temperatures, internal temperature is decreased and after few hours the room becomes cold. If the cooling continues, the internal temperature will be +10°C.
  • In internal temperature of +10 °C, a healthy man can sustain the body temperature if he puts on warm clothes. With adequate clothes and blankets, healthy man can sleep on that temperature.
  • If the internal temperature decreases less than 10°C, the energy is needed for  people which forms the muscular tissue with aim maintaining the bodily temperature.
  • For the vulnerable individuals it was recommended internal minimal temperature of 20°C, while temperature of 12°C is considered as risk for the health of the same.
  • By temperature of 16°C there is a risk of respiratory infections, while by temperature less than 12°C there is an increased risk of heavy effort on the cardiovascular system (Kolins, 1986).
  • After 2 hours or less than 6°C, deep internal temperature decreases and there is a risk of hyperthermia.

Recommendations for the representative of the local self government and centers for social work:

Provide shelter centers for intervention taking care of people under risk of cold weather and cold waves

To protect the health of the employed in condition of cold wave.

Doctor specialist of labor medicine should consider the working places with risk and workers who work outside in condition of low temperature.

  • Doctor specialist of labor medicine should be  informed, trained and ready for action, in conditions for professional exposition of  workers on low temperature, especially working outside, in the winter period.
  • The result for estimation of the risk from work on cold open places should be available for the Services for occupational health, during evaluation of the individual health state and working ability of the exposed workers, as well as determination of the preventing measures of the particular working places.
  • Services of occupational health, employed by the employer, have obligation for conducting of the preventive health controls of the employees who work in conditions of low temperature, in accordance with the Rulebook of the kind, manner and extent of the preventive health controls of the employees (Off. Gazette. 171/2010).
  • Services for occupation medicine have obligation to provide adequate information for the employers and employees who work in conditions of low temperature for the existing risk as well as use of suitable measures for handling the risk of low temperatures.

Recommendation for the employers

  • To establish policy and plan for acting during the job, in conditions of cold-low temperatures
  • To identify the working terms of the working place and to undertake suitable measures for working safety.
  • To inform the workers of the hazards on which are exposed during working outside, on low temperature as well as with measures which should be undertaken with aim for protection of life and health of the workers.
  • Informing the workers with cues and symptoms of diseases and injuries caused by cold.
  • Providing basic first aid kit and to train the workers for giving first aid.
  • Advising workers for adequate clothing in cold, wet and windy weather, including the layer clothes according to the changeable weather conditions.
  • In extreme cold conditions, to provide short working pauses in warm shelters
  • Organization the work in the hottest part of the day and to shorten the periods of outside working.
  • Avoid fatigue and exhaustion of workers because energy is needed for keeping the body temperature.
  • Usage alarm system-work in pairs (not isolated individual work), in case one worker to another, recognize the cues of hazard.
  • Providing   hot sweetened beverages.
  • Remember that  worker is faced with increased risk if particular medicaments are taken, if they are in weak physical condition or suffer from particular diseases such as diabetes, hypertension or other cardiovascular diseases.

Recommendation for employees:

  • Employees should be suitably informed of the hazards on which they are exposed while working outside, in conditions of low temperature, as well as measures that should be undertaken with aim protection of their life and health
  • Employees should be introduced with the cues and symptoms and injuries caused by cold,
  • Employees should be trained for first aid and to employ the following actions:
  • Immediately to put off wet clothes and shoes
  • Exposed body parts gradually to be warmed on room temperature
  • To give hot drink if the employee is conscious.
  • If the person is without pulse, to start resuscitation and call emergency
  • You should use layer, comfortable and warm clothes for cold, wet and windy weather, with hats (with protection on the exposed part of the head and neck- for example (caps and neck clothe and etc), adequate shoes (comfortable with good isolation of cold and humidity), socks (two pairs, it is better to be made of synthetics), gloves (with good isolation from cold and humidity).
  • It should be consumed bigger quantities of hot, sweetened drinks, but to avoid drinks with caffeine (for example coffee) and alcohol.
  • You should consume regular hot meals and high caloric food.

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