In depth: Balkan countries play Russian roulette with mosquitoes
Story Highlights
- We do have a tendency to always look at mosquitoes from the negative side, however, they are part of the ecosystem and of the food chain, especially in the aquatic world.
- There is capacity for treatment, but there are no experts for research.
- We cannot fight the enemy if we do not know the enemy, and that requires both experts and finances.
- Without proper mosquito population control we can potentially face serious health risks.
- Last year, the first pilot study was conducted in Serbia with the release of sterile male tiger mosquitoes, aimed at reducing the population of these insects.
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Headache, fever and muscle aches. A fellow citizen had the feeling that a cold was bothering his body. He was almost certain that the seasonal flu had taken over when he felt nauseous, but he expected to get over it.
The usual days for the common cold have passed and our fellow was still struggling with the same symptoms. Medical tests showed West Nile fever caused by a mosquito bite. He barely survived the apparently "mild" symptoms, but four others in the last two years were not so lucky and died from the same bite that transmitted the West Nile fever.
Epidemiologist Dragan Kochinski from the Institute of Public Health in North Macedonia says that the naïve treatment of mosquitoes sustains the number of sick people and fatalities from diseases caused by these insects.
"The largest percentage of clinical cases manifest as mild forms, with flu-like symptoms (temperature, headaches, muscle and joint pains). In addition, weakness, malaise, enlarged lymph glands, nausea, vomiting and a possible body rash appear, says Kochinski and points out that, in most cases, uncomplicated infections simply pass after 3-6 days.
There is capacity for treatment, but there are no experts for doing research.
"In those with severe, neuroinvasive forms of the disease, which is 1% (most common in the elderly) there are signs of encephalitis, meningo-encephalitis or meningitis - stiff neck, disorientation, tremors, convulsions, severe muscle weakness, flaccid paralysis and coma. Then there is a disturbance in the balance, damage to the cranial nerves, pain in the eyes, but also the appearance of myocarditis, pancreatitis, fulminant forms of hepatitis”, epidemiologist Kochinski explains.
2011-2023
| Diseases | Sick | Fatalities |
| Malaria: | 36 | 4 |
| West Nile fever: | 45 | 4 |
| Dengue: | 1 | / |
| Yellow fever, Zika and Chikungunya: | / | / |
Number of illnesses and fatalities in North Macedonia from diseases transmitted by mosquitoes
(Source: Institute of Public Health)
The figures are no different in neighboring Serbia. In September, the local media wrote about the last of a total of 91 cases when a sixty-five-year-old woman from Vojvodina was in a serious condition in the hospital in Sombor for almost two months. After she collapsed it was determined that she was infected with West Nile fever.
According to the data of the Public Health Institute of Serbia "Dr. Milan Jovanovic-Batut", published at the beginning of November, a total of 91 cases were registered this year, of which 54 men and 37 women, aged 18 to 89 years. Earlier this year, two deaths were reported that may be related to the disease. Both cases were registered in Vojvodina.
Five years ago, 192 cases of West Nile fever were registered in Vojvodina, which is 21 times more than a year earlier. At the same time, the fatality rate from this disease was the highest among all infectious diseases in Vojvodina registered in 2018, when as many as 31 people died.
In Albania, the Aedes mosquitoes are becoming more common, and these subspecies are known to be very efficient disease vectors. This country is their "favorite" because of the large water bodies in which mosquitoes see as paradise.
Dangerous and harmless mosquitoes
Nikolina Sokolovska is the only medical entomologist in North Macedonia. She works in the Center for Public Health and investigates mosquitoes.
"Mosquitoes are part of the ecosystem. We always see them from the negative side, that they disturb us, transmit diseases, but there is also a positive side. They are part of the food chain, especially for the aquatic ecosystem", says Sokolovska, but remains of the opinion that these are deadly insects.
"They are considered to be the deadliest, and the WHO also declares them to be the deadliest animals in the world. There are somewhere around 700 thousand deaths, although the largest percentage is in the tropics and subtropics, but still, this is a very high number. Because we travel globally, there is population migration, hence there is a danger in contagion, in transmission of diseases and so on, says Sokolovska.
We don't have the tropical diseases that exist around the world, but we do have mosquitoes that are carriers, emphasizes Sokolovska and adds that this is something that should not be neglected at all.
"There is a danger from mosquitoes. However, not all mosquitoes can transmit a virus. It is an entire chain in the nature – the mosquito feeds on an infected person or animal, so will the virus survive or replicate, will it multiply in the mosquito's body, will it transmit it to humans by feeding on it, will it spread to humans, will it survive in humans - these are the laws of nature that provide where they will multiply, where will the disease develop", explains Sokolovska.
Prof. Dušan Petrić PhD, a retired professor at the Faculty of Agriculture in Novi Sad, says that domestic mosquito species have been there for millions of years, but in the last ten years new species have been found in our region.
Dušan Petrić: The Asian tiger mosquito is a poor flier, so people help it spread
"They are new species thanks to increased intercontinental transport and trade, the people and thanks to climate change, especially higher temperatures which helps them settle in new areas where they did not live before," says Petrić and adds: "Invasive mosquitoes spread around the world primarily through the trade in used car tires, in which they can lay their eggs. Thus, the Asian tiger mosquito came from China to Albania in 1978, from Texas to Italy in 1990.
From the initial points of penetration, they spread mainly by means of transport – cars, buses, trucks, trains, yachts, ships and other means. The Asian tiger mosquito is a poor flyer, so humans help it spread. Another species, Aedes japonicus, can also actively spread."
Based on his decades of experience, Dr. Petrić warns that it is quite possible that in the future some new species of mosquitoes and some new viruses/diseases that these species transmit will appear in this climate, but also that climate change will contribute to an increase in the population of the species already living here.
It forces us to stay vigilant and cautiously monitor the situation, in order to react in time and not allow fatalities to occur.
But the epidemiologist Kochinski says that there is a lack of monitoring in North Macedonia.
Dragan Kochinski: We do not have routine monitoring of mosquitoes
"There is no routine monitoring of mosquitos. Center for Public Health Skopje sets baits at the level of the City of Skopje during the year, but those results are not sufficient to obtain national level data. Aedes albopictus (tiger mosquito) and Culex mosquitoes are already proven to exist", explains Kochinski.
Sokolovska states the same, with regret, emphasizing that we cannot fight the enemy if we do not know the enemy, and in order to get to know our enemy we need to have experts and finances.
"Well, we can't brag much here, because we don't have monitoring!" For the first time, on our initiative, a change was made in the National Program for Protection of the Population from Infectious Diseases last year, where it was added as an activity, but no additional funding was allocated. I will say again – within the program. Other activities can be reduced in order to transfer those funds to monitoring, but it is not only about the financial part – I can say that the professional team is also not satisfactory and we do not have enough people to do those activities on a nationwide level, says Sokolovska.
Sokolovska is responsible only for the territory of the City of Skopje. She says that on her own initiative and ambition, when she has the opportunity, she explores other cities throughout North Macedonia.
Albania: The desire for money prevails over fear
In order to protect the health of its citizens as well as the visiting tourists, the Albanian government initiated a program back in 2014 that started the "disinsection" campaign. This was the first time in 25 years that such a process took place in Albania. The then Minister of Health Ilir Beqaj announced the target areas for disinfection and since then the Albanian government has been hiring private companies to carry out this task via tender process.
However, in recent years, these tenders have failed to fulfill the task of disinfecting Albania's coastal areas, where tourism is booming.
Institute of Public Health (ISHP) and the State Agency for Centralized Procurement (ASHPP) in Albania sidestepped the issue, shifting the blame to each other and did not, in the meanwhile, continue with the task of disinfestation for the last five years.
For 2023, the tender race was underway, but was hampered by institutional non-accountability and lack of communication, with around 800,000 euros earmarked for tenders being put on hold.
Talks of corruption and ongoing arrests of senior government officials are making matters worse, as misappropriation of funds becomes a real problem.
As this occurs, the time frame for effective disinfection is reduced. Female mosquitoes lay their eggs in small pools of water during the month of May, where the larvae remain for most of their lives, amounting to 10-14 days. These larvae are easiest to kill at this time, but with the delays we are seeing this year, the disinsection is unlikely to be effective.
Without adequate mosquito population control, anyone living in or visiting Albania could potentially face serious health risks. In addition, the negative impact this may have on tourism will have serious economic repercussions.
In contrast to Albania, in Macedonia the tender procedure goes flawlessly. After the so-called mosquito season ends in November, until the next one starts in the spring, the recommendations of the experts are followed and the necessary insecticides are procured. The problem arises when compliance with the recommendations is done on selective basis and they uphold only thing that suit them.
Medical entomologist Nikolina Sokolovska says that for years they have been appealing not to plan aerial disinfestation, because it is not effective in populated areas and because during aerial disinfestation, apart from mosquitoes, all insects that will fly at that moment, wasps, bees, flies are also destroyed...
To deal with mosquitoes, their habitats must be reduced.
"If we were to take more integral measures, to reduce the habitats, to dry up the water bodies that we don't need, if we can't dry them, cover them, protect them and so on, then, if after all those measures, we have a number of mosquitoes, we will go for disinfection, but let's go for larvicide first. Water must be treated! Aerial disinsection is not recommended and it is unsuccessful in the city. Aerial disinfestation is recommended to be either on the outskirts or in inaccessible areas, or here, for example, in rice fields where we have a larger area, but there is no success in a populated area!", explains Sokolovska.
Research shows that if mosquito habitats are reduced, their numbers will be reduced by 10% to 20%.
"The strategy is to reduce their habitats first. It is a strategy that the whole world supports and advocates for educating the population – the population to be part of the protection system, in addition to the municipalities and Ministries that implement these measures", she adds.
Due to the large number of people infected with West Nile fever, radical measures are being taken in Vojvodina in order to suppress the population of the tiger mosquito (Aedes albopictus).
Experts from the Faculty of Agriculture from Novi Sad announced this summer that, this year, they plan to release as many as 800,000 sterile male tiger mosquitoes in more than 40 locations.
Last year, the first pilot study was conducted in Serbia by releasing 200,000 sterile male tiger mosquitoes over a four-week period, each with 50,000 individuals. The purpose of increasing the population of that type of mosquito is actually to reduce it.
This globally accepted method of reducing mosquito populations is used against invasive mosquito species, such as the Asian tiger mosquito, because female tiger mosquitoes only mate once in a lifetime: if they mate with a sterile male, they will not produce offspring and will only lay sterile eggs.
Based on all our conversations in this analysis, the views of experts and data from relevant institutions, it can be concluded that a frivolous approach to deal with mosquitoes can result in a lot of money for the individuals in the short term, but in the long term it will become a threat to the health of the people. Seeing the current situation in North Macedonia, Albania and Serbia, the message is that this problem must be understood in a more responsible manner and that the funds invested should be in the right place and for the right purpose. There is no need to invent new ways – simply follow examples in the world that are already showing results.
This content was created by the Institute of Communication Studies.
Journalists: Katerina Topalova-Dejanovska (Macedonia), Denis Kolundzhija (Autonomija, Serbia), Gjon Rakipi, Jerina Rakipi (Tirana Times, Albania)
Photographer and photos: Sladjan Milosevski
Editing: David Milosevski
Top photo credit: Illustration (Public domain photo)
This news article was done within the project “Use of facts-based journalism to raise awareness of and counteract disinformation in the North Macedonia media space (Use Facts)”, which is implemented by the Institute of Communication Studies. The project is funded by UK aid from the Government of the United Kingdom, with the support of the British Embassy in Skopje. The views expressed do not necessarily reflect the UK government’s official policies.
