Date: Tue 31 Jul 2018
Source: Ekathimerini [edited]
<http://www.ekathimerini.com/231297/article/ekathimerini/news/two-new-cases-of-west-nile-virus-in-northern-greece>

Two new cases of West Nile virus were recorded in Central Macedonia, bringing the total for the region to 6, the state-run Athens-Macedonian news agency reported on [Tue 31 Jul 2018].

>From the start of the summer season, 22 cases of the virus have been reported by the Center for Disease Control and Prevention (KEELPNO) throughout the country, based on the last data it published on [Thu 26 Jul 2018].

"Two people are being treated in hospital for precautionary reasons," Dimitris Hatzivrettas, the deputy regional governor for Central Macedonia, responsible for public health, told the Athens News Agency - Macedonian Press Agency (ANA-MPA).

Hatzivrettas said the other 4 patients have been discharged and are in good health.
========================
[HealthMap/ProMED-mail map:
Greece: <http://healthmap.org/promed/p/83>]
Date: Thu 24 may 2018
Source: Pravda [in Serbian, trans. NP, edited]
<http://www.pravda.rs/2018/5/24/uznemirujuci-video-iz-sirije-stigla-smrtonosna-kozna-bolest-dosla-do-makedonije-i-crne-gore-ide-ka-srbiji/>

A deadly skin disease has arrived from Syria: it has reached Macedonia and Montenegro, heading to Serbia. Cutaneous leishmaniasis [CL], which has spread in Syria and the Middle East is approaching the Balkans, and there are already several cases in our area [the Balkans].

The main reservoirs of the disease are dogs, and the infection is transmitted to humans by sand flies. The symptoms are open wounds, bleeding from the nose and, according to the epidemiologist, diagnosed in Macedonia and Montenegro.

"If it hasn't come yet, it will come. This fact is absolutely not [discussed]. It spreads mainly from dogs and small rodents. Thus, we are talking about the disease, which are in the veterinarian's area of interests. Taking in account that this disease is confirmed in Macedonia and Montenegro. If we still have people who are infected in these countries then we will have leishmaniasis, " says the Professor. Dr. Teodorovic.

Leishmania, may carried by sand flies, and the main route of transmission from dogs to people. Infection is not transmitted from person to person. It can only theoretically be transmitted through blood (transfusion).
====================
[In Macedonia, between 1996 and 2009, 85 Leishmaniasis cases were diagnosed, with 50 percent coming from the central part of the country. In a survey held in 2005, 13 percent of dogs were found to be infected. The species is L. infantum  (<http://www.who.int/leishmaniasis/resources/THE_FORMER_YUGOSLAV_REPUBLIC_OF_MACEDONIA.pdf>).

In Montenegro, from 1992 to 2013, 66 cases of leishmaniasis were identified of which only one was cutaneous the rest was visceral Leishmaniasis (VL) (Medenica S, Jovanovic S, Dozic I, Milicic B, Lakicevic N, Rakocevic B. Epidemiological Surveillance of Leishmaniasis in Montenegro, 1992-2013. Srp Arh Celok Lek. 2015;143:707-11. <https://www.ncbi.nlm.nih.gov/pubmed/26946766>).

In Serbia, a few cases of VL are seen and most have a travel history to the coastal areas of Montenegro (Dakic ZD, Pelemis MR, Stevanovic GD, et al. Epidemiology and diagnostics of visceral leishmaniasis in Serbia. Clin Microbiol Infect. 2009 Dec;15(12):1173-6. doi: 10.1111/j.1469-0691.2009.02768.x.  <https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)64863-1/pdf>).

>From the text it is not clear why it is hinted in the news article that the Leishmaniasis cases come from Syria. Only Macedonia and Montenegro is mentioned, but the news is published in Serbian media. Clearly they are speaking of Balkan nationals and one possibility is that the persons infected participated in relief work, but it is also known that mercenaries from these countries participate in irregular military activity, and ProMED has previously reported cutaneous leishmaniasis in all participants in the Syrian civil war (see below). - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Republic of Macedonia: <http://healthmap.org/promed/p/76>
Montenegro: <http://healthmap.org/promed/p/480>
Syria: <http://healthmap.org/promed/p/86>]
Date: Thu 27 Jul 2017
Source: China.org [edited]
<http://www.china.org.cn/world/Off_the_Wire/2017-07/27/content_41292890.htm>

A total of 2 people, a father and a son, died within 48 hours at the Clinic for Infective Diseases here [Macedonia] after suffering from symptoms of an undiagnosed illness, Macedonian health authorities revealed on [Wed 26 Jul 2017]. The 2 were admitted to hospital with high fever and vomiting, and their condition quickly worsened.

The father and son lived in the village of Simnica, near the western Macedonian town Gostivar. At least 4 other inhabitants of the same village have been hospitalized with light symptoms of the apparently contagious disease.

According to the director of the Commission for the Prevention of Contagious Diseases, Zvonko Milenkovic, there is no need to raise the alarm among the citizens. "In this specific case, it is certainly not a disease with a high degree of transmission among humans. This is the reason that I don't see any need to create panic or insecurity among the people," Milenkovic told Xinhua in Skopje on [Wed 26 Jul 2017].

The authorities suspect the infectious disease might be a dangerous hemorrhagic fever transmitted by ticks and rodents, or a case of the mosquito-born West Nile virus.

One of the reasons the disease has yet to be determined is the lack of the needed reagents at the country's cash-strapped Institute for Public Health, Macedonian media revealed. The institute's financial situation has been poor and its accounts have been blocked for some time due to unpaid electricity bills. "Aside from all the difficulties that the institute has faced in recent period, we managed to get the reagents. We expect the results from the analysis by tomorrow afternoon," the institute's director Shaban Memeti said to web portal Nova TV.
=====================
[Not very much history or clinical description of the illness is given for the 2 men who died or the others who are more mildly affected; but for some reason "authorities" suspect tick-borne hemorrhagic fever. So there may be a history of tick exposure and hemorrhagic manifestations. ProMED-mail would appreciate more information from knowledgeable sources about these cases.

Simnica, with a population of 430 residents, is a village in the municipality of Gostivar, in northwestern Macedonia
(<https://en.wikipedia.org/wiki/Simnicaa>).

A map of Macedonia that shows the location of Simnica can be found at:
<https://www.google.com/maps/place/Simnitsa,+Macedonia>. - ProMed Mod.ML]

[The report mentions ticks, suggesting that the authorities might suspect Crimean-Congo hemorrhagic fever. A hantavirus could possibly be involved, including Dobrava-Belgrade or Seoul viruses. These hantaviruses do not involve arthropods in their transmission to humans. Clearly, a thorough laboratory work up is needed to determine the etiology responsible for these cases. - ProMed Mod. TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/62217>.]
Date: Sun, 11 Sep 2016 21:46:22 +0200

Skopje, Sept 11, 2016 (AFP) - A moderate 5.3-magnitude earthquake, preceded by two and followed by several tremors, struck the Macedonian capital Skopje on Sunday, causing panic but only minor damage, officials said.   Skopje was almost destroyed by a powerful quake in 1963 which killed around a thousand people.

Sunday's quake hit at 3:10 pm (1310 GMT), with the epicentre in the Skopje area, seismologists said, adding some 10 weaker tremors were later registered.   "In Skopje and surroundings some damages have been reported that occurred on older buildings," the country's seismological service said in a statement.

The quake was felt throughout the Balkan country, Dragana Cernic of the seismological service said earlier citing reports on minor damage, such as cracked walls and broken furniture.   However, some 60 panicked Skopje residents sought hospital treatment, some sufferting broken limbs while trying to flee.   All but three were later discharged, hospital officials said.

Parts of Skopje were without power and some mobile phone providers were down.   Many residents said they were terrified.   "I don't know what to do. I don't want to return to my building," a fearful Skopje resident, Mirjana Jovanovska, who remembered the 1963 quake, said outside her home.   "It was horrible... I was in a hospital when it happened and everyone ran outside, including patients on a drip, everyone," Dani Kavadarska, a 53-year-old woman, told AFP. "There is not a single doctor or nurse left inside."   On Sunday evening many Skopje residents were still on the streets or in parks fearing to return to their homes.
Date: Mon, 13 Jun 2016 20:21:42 +0200

Skopje, June 13, 2016 (AFP) - Marijuana-derived medicines became legal on Monday in Macedonia, which joined over a dozen European countries that have already authorised the products for certain patients.   Medicines containing less then 0.2 percent of tetrahydrocannabinol (THC), the plant's main psychoactive ingredient, can now be prescribed by doctors and bought in pharmacies, the head of Macedonia's agency for medicines Marija Darkovska-Serafimovska told reporters.   "This will help a huge number of Macedonian citizens that are fighting serious illnesses and have a need for treatment with nature-based products," Darkovska-Serafimovska said.   The medicines are available to patients battling health problems linked with cancer, multiple sclerosis and epilepsy.

The marijuana-derived products are, however, only accessible under doctors' supervision and with a prescription.   "This is not a replacement for medical treatment," Health Minister Nikola Todorov said after parliament passed in May the new law allowing the sales following months of public debate.   Other marijuana use remains illegal under Macedonian law.   So far 13 European Union nations have legalised marijuana-derived medicines including Austria, Britain, France, Germany, Italy, the Netherlands and Spain.   Macedonia applied for EU membership in 2005 but has yet to open accession talks.
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