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Macedonia



Capital: Skopje

Time Zone: +1 hour. GMT +1 hour daylight savings time.
Tel. Country Code: 389
USADirect Tel.: 99
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.


Travel Advisory - Macedonia

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Macedonia


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• U.S. Embassy 
Ilindenska bb, 1000 
Skopje 
Tel: [389] (2) 311-6180
Fax: [389] (2) 321-3767 
E-mail: consularskopje@state.gov
Website: http://skopje.usembassy.gov

The Government of Canada does not have an embassy in Macedonia. Diplomatic contacts are through the Canadian Embassy in Serbia.

• Embassy of Canada
Kneza Milosa 75
Belgrade, Serbia
Tel: [38] (11) 306-3000
Fax: [381] (11) 306-3042
E-mail: bgrad@international.gc.ca
Website: http://www.international.gc.ca/canada-europa/serbia

• British Embassy
Salvador Aljende No. 73
Skopje 
Tel: [389] (2) 3299 299 
Facsimile: [389] (2) 3179 726 (Consular/Visa) 
Email: Consular.Skopj@fco.gov.uk 
Website: www.britishembassy.gov.uk/macedonia

Entry Requirements

U.S. citizens need a passport to enter Macedonia. A visa for Macedonia is not required for tourist/business purposes for stays up to 90 days. For stays longer than 90 days, American citizens need to obtain the appropriate visa at a Macedonian Embassy or Consulate prior to their trip. Additional information on entry requirements may be obtained from the Macedonian Embassy at 2129 Wyoming Ave. NW, Washington, DC, 20008, telephone (202) 667-0501; fax (202) 337-3093; or the Macedonian Consulate General in Detroit, 2000 Town Center, Suite 1130, Southfield, MI 48075; telephone (248) 354-5537; fax (248) 354-5538. 
Visit the Embassy of Macedonia website at: http://www.macedonianembassy.org for the most current visa information.

HIV Test: Not required.

Required Vaccinations: None required.

Passport Information

Macedonia is a parliamentary democracy that is steadily transforming its economy. Tourist facilities are available in the capital, Skopje, and other major towns. In tourist centers, such as Skopje and Ohrid, European-standard hotels and other travel amenities are available, while the standard of facilities throughout the rest of the country varies considerably. 

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant. 
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to hotels or resorts.

Hospitals / Doctors

Although many Macedonian physicians are trained to a high standard, and a number of well-equipped private clinics are available especially in Skopje, most public hospitals and clinics are not equipped and maintained at U.S. or Western European standards.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available or may be of unreliable quality. 
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that cannot be treated locally, every effort should be made to arrange medical evacuation to Western Europe. 

The U.S. Embassy maintains a list of doctors and hospitals at:http://skopje.usembassy.gov/medical_information.html

• Re-Medika General Hospital 
XVI Macedonska Brigada 18
Tel: [389] (2) 260 31 00
Skopje
Website: http://www.remedika.com.mk/index_en.htm
Medical/surgical facility with ob/gyn and cardiology services.

• State University Hospital
Skopje
Tel: [389] (2) 314 72 22
For in-patient care.

• Military Hospital
Ilindenska Blvd b.b.
Skopje
Tel: 306 26 22
For in-patient care.

• Neuromedica (2 locations in Skopje)
Vlae num. 87 
Skopje 
Tel: [389] (2) 204 23 23 
Website: http://www.neuromedica.com.mk/Default-en.aspx
Complete medical health care 24 hours per day, including home visits. Specialists in family medicine, surgery, pediatrics, neurology, ENT, dentistry with dental surgery, ophthalmology, urology pulmonary medicine, rheumatology; ultrasound, CT, MRI diagnostics, laboratory.

• Neuromedica 
Juzen Bulevar nn
Skopje
Tel: [389] (2) 313 33 13

• Neuromedica also has a clinic in Komanovo
Bratstvo i Edinstvo no. 25 
Kumanovo
Tel: [389] (31) 414 033

• Dr. Thomas A. Buckingham 
Slovak Cardiovascular Institute
Pod Krasnou Horkou 1
Bratislava
Tel: [421] 90 597 8573
Internal Medicine and cardiology.

Destination Health Info for Travelers

AIDS/HIV: In most countries the HIV epidemic is driven by behaviors (e.g., multiple sexual partners, commercial sex, injecting drug use) that expose individuals to the risk of infection. In Macedonia, the epidemic is predominantly urban, young, male, injecting drug users and their sexual partners and other transmission groups which account primarily for the rise in HIV/AIDS in this country. Central Europe, however, has been relatively spared by the HIV epidemic, with the incidence of both AIDS cases and newly diagnosed HIV infections remaining low. The prevalence of adults living with HIV in Macedonia is estimated at 0.2%. (Source: Avert.org)
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids or blood of another person. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Avian Influenza A (Bird Flu): There are no reports of avian influenza in this country.

Crimean-Congo Hemorrhagic Fever (CCHF): Crimean Congo hemorrhagic fever (CCHF) is endemic to Kosovo, just to the north of Macedonia. Although, most cases of CCHF occur in the region of Central Kosovo, during the summer months other rural areas of Kosovo can be affected. CCHF is caused by a virus and is transmitted by tick bite or by exposure to blood or secretions from infected animals or humans. Anyone who has visited Macedonia and is suffering from a fever, headache, chills, muscle aches, vomiting, red rash (which does not fade when pressed under glass), bleeding on the roof of the mouth, or any other unexplained symptoms should seek medical advice immediately. Risk is seasonal, associated with periods of high tick activity (usually March through September, but seasonal patterns may occur) and increases in tick and rodent host populations.

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation. Hepatitis E has been reported regionally, but levels in Macedonia are unclear. Transmission of the hepatitis E virus (HEV) occurs primarily through contaminated drinking water. In developing countries, prevention of HEV relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 2% to 7%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic in the general population, but levels are unclear. The prevalence of hepatitis C antibodies in neighboring Greece is 1.5%. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Lyme Disease: Risk of transmission occurs in rural brushy, wooded, and forested areas up to 1,500 meters elevation. The ticks that transmit Lyme disease are most abundant and active April through September. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference:http://content.nejm.org/cgi/content/abstract/345/2/79).

Other Diseases/Hazards: Anthrax (enzootic foci exist, with outbreaks in livestock reported; human exposure usually is associated with slaughter of infected animals), brucellosis (in Macedonia, up to 10% of domestic livestock tested during the 1990s were infected with brucellosis; human infection usually is contracted by consumption of unpasteurized dairy products or exposure to livestock), tick-borne relapsing fever (enzootic; vectored by soft ticks, usually in rural, livestock-tending areas with dense shrubs and bushes, where ticks vectors present).

Rabies: This disease occurs in wild animals countrywide-primarily in foxes, with sporadic cases reported in domestic animals, primarily cats and dogs. Human cases are occasionally reported. Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.

Tick-Borne Encephalitis (TBE): Travel in forested areas in the Republic of Macedonia brings the risk of exposure to tick-borne encephalitis. Sporadic cases occur in rural brushy and forested areas country-wide at elevations up to 1,500 meters. 
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.

Tuberculosis (TB): Tuberculosis is moderately endemic in Macedonia with an annual occurrence greater than or equal to 25 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid vaccine is recommended by the CDC for all unvaccinated people traveling to or working in the Balkans and Central Europe, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.