North Macedonia reports five deaths and 43 West Nile virus cases as European infections climb

Outbreak in Skopje

The Ministry of Health in North Macedonia announced on Saturday that five people died after contracting West Nile virus during the ongoing summer wave. Health authorities identified 43 human infections across the Balkan state, with the majority detected over the previous three weeks alone. In early August, government officials declared an epidemic across multiple municipalities in and around the capital city of Skopje. Inpatient numbers grew at specialized facilities as symptomatic individuals required urgent hospital care. Fadil Cana, the director of the Clinic for Infectious Diseases in Skopje, described the continuous flow of admissions.

Almost every day someone is admitted to hospital, and the number of patients in the clinic is around 20 to 21.

Countermeasures and epidemiological history

Municipal teams carried out extensive ground and aerial insecticide spraying operations, focusing on irrigation canals, wetlands, and other water bodies where mosquitoes multiply. On Friday, Health Minister Sašo Klekovski urged citizens to drain private swimming pools to remove standing water and instructed residents to report dead birds to veterinary authorities. North Macedonia first documented West Nile virus in 2011 and registered 54 cumulative cases between 2011 and the end of 2025. The 43 infections detected in 2026 follow an exceptionally hot summer that accelerated transmission across the country.

Clinical risks and transmission cycle

The virus was first identified in 1937 in the West Nile district of Uganda and has circulated in Europe since the 1950s after introduction by migratory birds from Africa. The transmission cycle depends on mosquitoes biting infected birds and transferring the pathogen to humans. Humans serve as epidemiologically dead-end hosts, meaning they cannot transmit the virus further. Approximately one in four infected individuals develops clinical symptoms after an incubation period of two to 14 days. While mild cases produce fever and tremors, severe neuroinvasive infections can cause coma and life-threatening meningitis. According to the World Health Organization, there are no approved human vaccines or targeted medical treatments.

Continental spread and climate drivers

On Friday, the European Centre for Disease Prevention and Control announced that 12 European countries have registered locally acquired cases since the start of 2026. The list comprises North Macedonia, Austria, Germany, the Netherlands, France, Spain, Italy, Albania, Greece, Romania, Serbia, and Kosovo. In 1996, Romania recorded 393 infections during an outbreak. European transmission occurs between spring and autumn, peaking from July through September. Virologist Leen Delang at KU Leuven demonstrated that local Culex pipiens mosquitoes can carry the pathogen in their saliva. Wageningen University in the Netherlands has also initiated studies into regional transmission dynamics. Wim Thiery, a climate scientist at Vrije Universiteit Brussel, linked transmission risks to warmer winters, dry summers, and elevated temperatures.

Unlike coronavirus, this is a virus where climate factors are very important for potential infections.