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MASA
МАНУ
CONTRIBUTIONS. Sec. of Med. Sci., XLIV 3, 2023
ПРИЛОЗИ. Одд. за мед. науки, XLIV 3, 2023
ISSN 1857-9345
ABSTRACT
The main goals of this research are to determine the developmental tendency of salmonellosis in the
Republic of North Macedonia and to determine the index of dynamics and the rate of decline/increase of
salmonellosis in the Republic of North Macedonia. The research covers the period from 01.01.2012 until
31.12.2022. The data used to implement this study were obtained from the Institute of Public Health of
the Republic of North Macedonia. The research included 2711 subjects who were sick with salmonellosis
from 2012 to 2022. The following statistical methods of work are used: linear trend, dynamic index with a
constant base, dynamic index with a variable base (chain index), rate of decline, and rate of increase. The
results of the study suggest that in the period 2012-2022, the highest number of patients (n=373) and the
highest incidence (18/100000) of salmonellosis were registered in 2018, and the lowest in 2020 (n=119,
I=5.8/100000). From the linear trend values, it can be concluded that salmonellosis in the Republic of
North Macedonia shows a decreasing tendency. The biggest increase in salmonellosis in the Republic of
North Macedonia was in 2015 by 71% compared to 2014. The biggest decrease in salmonellosis in the
Republic of North Macedonia was in 2020 by 48% compared to 2019. From the study, it can be concluded
that food operators and manufacturers are observing the procedures of the HACCP control system for food
safety, leading to a possible decrease in salmonellosis.
Keywords:salmonellosis, trend, index, pace, decline, rise
INTRODUCTION
Corresponding author: Besim Memedi, besim.memedi@rezonanca-rks-com
1
"Resonance" College, Veternik, Pristina, R. Kosovo
2
VT diet club, Jane Sandanski St. 15, Bitola, R. N. Macedonia
Besim Memedi1
and Vlatko Tanevski2
INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS
IN THE REPUBLIC OF NORTH MACEDONIA
Salmonella is the causative agent of intes-
tinal typhus (Salmonella enterica serovar typhi),
paratyphoid (Salmonella paratyphi A, B, C), or
food poisoning (salmonellosis, alimentary tox-
oinfections).
Intestinal typhus is a severe, acute, infec-
tious disease manifested by bacteremia, septice-
mia, continuous high fever, hepatosplenomega-
ly, and skin changes on the abdomen and chest.
Paratyphoids (A, B, C) are similar to typhus, but
have a much milder clinical picture. Patients may
have constipation or diarrhea.
Animals are the main reservoir for salmo-
nella bacteria. Humans are the only carriers of ty-
phoid salmonellas. These salmonella bacteria are
transmittedthroughafecal-oraltransmissionmech-
anism, with direct and indirect contact, through
contaminated water, food (milk and dairy products,
fruits, vegetables, shellfish), soil, and insects.
Salmonellosis is caused by "atypical sal-
monella bacteria" of which there are about 2500
serological types. The most significant and com-
mon are Salmonella typhimurium and Salmonella
enteritidis [1]. Salmonellosis can occur in two
10.2478/prilozi-2023-0046
50 Besim Memedi and Vlatko Tanevski
clinical forms, acute enterocolitis (enteritis) and
alimentary toxoinfection (acute gastroenteritis).
It rarely causes septicemia with a clinical picture
of typhus [7].
Alimentary toxoinfections are caused by
"non-typhoidal salmonella bacteria" which have
about 2500 serological types. The most significant
and common are Salmonella typhimurium and
Salmonella enteritidis.
They cause acute infectious diseases that
often occur in the form of epidemics. The dis-
eases are manifested by nausea, vomiting, and
diarrhea (watery or dysenteric in a smaller number
of cases). They represent a risk for the elderly and
children with reduced immunity.
These diseases are zoonoses because the
main reservoir and source of infection are do-
mestic and wild animals (pigs, poultry, cattle,
sheep, and rodents) [1]. The reservoir can be a
sick, convalescent carrier, as well as asymptomatic
cases, the so-called healthy germ carriers. Chronic
germ carriers are rare in humans but are present
in animals [7]. Salmonella bacteria are transmit-
ted through contaminated food of animal origin
(meat and eggs), and less often through water or
contact [1].
GOALS
The main objectives of this research are:
• To determine the development tendency
of salmonellosis in the Republic of North Mace-
donia;
• To determine the indexes of dynamics
and the rate of decrease/increase of salmonellosis
in the Republic of North Macedonia.
MATERIAL AND METHODS
Research material
The focus of this research is to examine
the dynamics of salmonellosis in the Republic of
North Macedonia. The research was conducted
by the College "Resonance" in R. Kosovo and
VT diet club - Bitola, R. N. Macedonia. The re-
search covers the period from 01.01.2012, until
31.12.2022. The research is of a retrospective
type. The data we used to conduct this research
was taken from the annual report on the move-
ment of acute infectious diseases in the Republic
of North Macedonia in 2022, which was issued
by the Department of Epidemiology of Infectious
Diseases at the Institute of Public Health of the Re-
public of North Macedonia. The research included
2711 subjects who were sick with salmonellosis
from 2012 to 2022.
Research methodology
The research included 2711 patients with
salmonellosis from 2012 to 2022. To conduct this
research, it was important to meet certain criteria:
The study should include cases of salmo-
nellosis;
The study should include both sexes.
Statistical method of data processing
The following statistical methods were used:
linear trend, dynamic indexes with a constant
base, dynamic indexes with a variable base (chain
indexes), rate of decline, and rate of increase. The
data are presented tabularly and graphically.
RESULTS
Table 1 shows data on the number of pa-
tients and the incidence of salmonellosis in the
Republic of North Macedonia for the period from
2012 until 2022. The data was taken from the an-
nual report on the Movement of acute infectious
diseases in the Republic of North Macedonia in
2022, issued by the Department of Epidemiology
of Infectious Diseases at the Institute of Public
Health of the Republic of North Macedonia.
Year
Number of
diseased
I /
100000
2012 245 11.9
2013 262 12.7
2014 204 9.9
2015 348 16.8
2016 254 12.3
2017 317 15.3
2018 373 18
2019 228 11
51
INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA
2020 119 5.8
2021 194 9.4
2022 167 9.1
Table 1. Salmonellosis, number and I/100000,
R. N. Macedonia, 2012-2022
From Table 1, it can be concluded that in the
period 2012-2022, the highest number of patients
(n=373) and the highest incidence (18/100000)
of salmonellosis were registered in 2018, and the
lowest in 2020 (n=119, I=5.8/100000) [2].
To determine the development tendency of
salmonellosis in the Republic of North Macedo-
nia, it is necessary to create a trend. There are
several types of trends: linear, parabolic, logarith-
mic, etc. The line trend is mostly used. It is made
according to the formula:
y = a + bx
In the formula where y the trend value is
expressed, a and b are trend coefficients, and with
x, time is indicated. The value of the trend coeffi-
cients is determined by the formulas:
Table 2 shows the procedure for determin-
ing a linear trend. In Table 2, the time values (X)
are determined in such a way that the middle year
(2017) in the analyzed period is marked with 0
(X=0). The values of (X) above zero are marked
as: -1, -2, -3, -4, -5, and below zero 1, 2, 3, 4, 5. Y
shows the individual frequencies of salmonellosis
in the analyzed period. X ×Yshows the individual
products, and when calculating the sum, attention
should be paid to the negative sign.
Year X Y X × Y X2
2012 -5 245 -1225 25
2013 -4 262 -1048 16
2014 -3 204 -612 9
2015 -2 348 -696 4
2016 -1 254 -254 1
2017 0 317 0 0
2018 1 373 373 1
2019 2 228 456 4
2020 3 119 357 9
2021 4 194 776 16
2022 5 167 835 25
∑ 2711 -1038 110
Table 2. Salmonellosis in the
Republic of North Macedonia 2012-2022
By replacing the corresponding values, the
values of the trend coefficients, as well as the trend
itself, are determined:
y = a + bx = 246.45 – 9.44 x
In further elaboration, trend values for each
year are determined (Table 3).
Year
y = a + bx =
246.45-9.44x
2012 291.45
2013 282.45
2014 273.45
2015 264.45
2016 255.45
2017 246.45
2018 237.45
2019 228.45
2020 219.45
2021 210.45
2022 201.45
2023 189.81
2024 180.37
2025 170.93
Table 3. Determination of trend values for
salmonellosis in the Republic of North Macedonia
The obtained individual trend values in the
examined period are applied in a coordinate sys-
tem (Graph 1).
52 Besim Memedi and Vlatko Tanevski
From Graph 1, it can be seen that salmonel-
losis in the Republic of North Macedonia shows
a decreasing tendency.
For the years 2023, 2024, and 2025, a fore-
cast was made for the trend values (only the values
for time X are changed in the trend formula), and
it can be seen that even in the years of the forecast
salmonellosis shows a tendency to decline.
Dynamics indexes allow the analyzed phe-
nomena to be seen as relative variations over time.
There are two types of momentum indexes: con-
stant-base momentum indexes and variable-base
momentum indexes (chain indexes).
In dynamic indexes with a constant base,
the base can be the smallest or largest number in
a time series, that is, it can be the average value
as in this study. Once the base is determined, the
time series data is brought into relation with the
base, expressed as a percentage. A disadvantage
of constant-base indexes is that adjacent dynamic
indexes cannot be compared. The comparison is
always with the base (Table 4).
Dynamic indexes with a variable base
(chain indexes) are determined in such a way that
the frequency (number, value) of the analyzed
phenomenon for the corresponding year is divided
by the frequency of the previous year. Dynamic
indexes with a variable base allow mutual com-
parison of the values for each year of the time
series (Table 4).
Graph 1. Salmonellosis in the Republic of North Macedonia, trend, 2012-2022
Year
Number
of
diseased
Indexes
Permanent
base
Variable base
2012 245 100% ∕
2013 262 107% 107%
2014 204 83% 78%
2015 348 142% 171%
2016 254 104% 73%
2017 317 129% 125%
2018 373 152% 118%
2019 228 93% 61%
2020 119 49% 52%
2021 194 79% 163%
2022 167 68% 86%
Table 4. Dynamic Indexes / Salmonellosis in the
Republic of North Macedonia 2012 - 2022.
Table 4 shows that the index of dynamics
with a constant base is highest in 2018 when it
is 152%, compared to the base in 2012 which is
100%. The lowest value is in 2020, when it is 49%
compared to the base in 2012 (100%).
In dynamic indexes with a variable base
(chain indexes), the salmonellosis index in 2015
was 171% compared to the index in 2014, which
was 78%. This is also the highest dynamic index
with a variable base. The index in 2020 has the
lowest value of the indexes with a variable base
(52%) compared to the index in 2019, which is
61%.
53
INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA
Looking at Table 4, it is possible to deter-
mine the decrease or increase of salmonellosis
in the Republic of North Macedonia during any
interval of the analyzed period (2012-2022). In
this study, the rate of increase for 2014-2015 has
been determined, because this period presented the
greatest increase in salmonellosis in the Republic
of North Macedonia. Also, the rate of decline is
calculated for the period 2019-2020, in which the
most significant decline of salmonellosis is record-
ed in the Republic of North Macedonia (Table 5).
Rate of decrease Rate of increase
2019 228 2014 204
2020 119 2015 348
Decrease 48% Increase 71%
Table 5. Rate of decrease and rate of increase
/ Salmonellosis in the Republic of North Macedonia
2012 - 2022.
From Table 5, it can be concluded that the
rate of decrease in salmonellosis in 2020 is 48%,
and the rate of increase (growth) in salmonellosis
in 2015 is 71% compared to 2014 [3].
DISCUSSION
Because the Salmonella spp. bacteria easily
reproduce in food without changing their organo-
leptic properties, the population, when consuming
food, often does not even assume that they have
already been poisoned by it. Therefore, bacterio-
logical monitoring of salmonellas has a preven-
tive role for infectious diseases transmitted by
unsafe food. A retrospective study covering the
period from 2016 to 2020 found that Salmonella
spp. is in first place among the total number of
detected bacteria in the examined samples in the
microbiological laboratory at CPHS (Center for
Public Health - Skopje). In the investigated five-
year period in the bacteriological analysis of food
samples, Salmonella spp. was detected 24.4% of
the time. Of the total number of 7094 salmonel-
las detected in food samples from imports, 6.9%
are accounted for, while 93.1% are from domes-
tic production. In the total number of samples
taken for bacteriological examination according
to bacteria in the trade and domestic production,
artisanal production participates with 69.3%. The
percentage of defective samples of Salmonella
spp. in the researched period amounts to only 3,
or they range from 0.06% in 2016 to 0.10% in
2020. In trade and domestic production, all three
defective samples were detected, and in craft pro-
duction, there were two defective samples and one
sample in 2016 came from industrial production.
In conclusion, during the five-year analysis of
food samples received for bacteriological exam-
ination of the most common groups of bacteria
that appear in the unsafe samples during the an-
alyzed period, which were examined in the bac-
teriological laboratory at the CPHS, Salmonella
spp. is in first place, followed by Escherichia coli,
the total number of Enterobacteriaceae species,
molds, yeasts, and other bacteria. The percentage
of defective samples of the aforementioned bac-
teria is insignificant and it indicates that the food
consumed is safe for consumers and that the op-
erators and manufacturers observe the procedures
of the HACCP food safety control system [4].
It is thought that in the year 2000, at least
2 million people worldwide died from diarrhea
caused by bacteria from the genus Salmonella.
In the United States of America, salmonellosis is
the cause of approximately 1.3 million foodborne
illnesses, with approximately 15,000 hospital-
izations and 500 deaths annually, accounting for
15.1% of incidences followed by campylobacte-
riosis (13.8%) and shigellosis (Schroeder, 2005).
According to the reports of the European Food
SafetyAgency (EFSA, 2012), Salmonella enteriti-
dis was isolated in 41.3% of the confirmed cases of
salmonellosis in people from the European Union
countries. The research of Papadopoulos et al.
(2016) determined that the strains of Salmonella
eneritis circulating through the food chain match
the serotype profiles of Salmonella enteritidis in
Europe. In the Republic of Serbia, Salmonella
enteritidis was the most frequently isolated Sal-
monella serotype from food products, although
Salmonella typhimurium was also rarely isolated
(Rašeta et al, 2014).According to research by Pav-
lović, Maris, Zlatar & Purtić-Klajić (2014), in the
period from 2011 to 2013 in the territory of the city
of Belgrade, the share of salmonellosis was 80.4%
of all recorded alimentary epidemics. Cakes and
sweets (22.2%), eggs (8.9%), and roasted chicken
meat (4.4%) were determined as the most common
source of salmonellosis epidemics. This is sup-
ported by the research of Ban, Vodopija Petrović
& Matica (2011), who, studying the epidemiology
of salmonellosis in the Republic of Croatia in the
period 1990-2009, determined that the most fre-
quently isolated serotype of Salmonella, as much
as 84%, was Salmonella enteritidis.According to
the same authors, in 32% of the cases, infected
54 Besim Memedi and Vlatko Tanevski
eggs were the source of infection, and in 10%,
poultry. In these epidemics, as a source of sal-
monellosis, the share of pasta was no less (10%).
Ivić-Kolevska & Kocić (2009) determined that in
the period from 2003 to 2005, as well as in 2006
and 2007, the most common source of salmonella
in our country was chicken meat, but also milk,
dairy products, and some types of sweets [5].
Salmonellosis in the Republic of North
Macedonia in the period from 2012 to 2022 shows
a decreasing tendency due to the following factors:
improved water quality, more frequent control of
sanitary-hygienic inspection in enterprises where
food products are produced, stored, transported,
and consumed, the way of eating, hygiene, as well
solutions to ban facilities, thus cutting the chain of
infection [6]. The biggest decrease in salmonel-
losis in the Republic of North Macedonia was in
2020 by 48% compared to 2019. This can be the
result of the COVID-19 pandemic.At the height of
the COVID-19 pandemic, all other diseases were
neglected, and the fight was directed only against
COVID-19 within the health system.
CONCLUSION
Salmonellosis are diseases that are found
all over the world. Due to better registration and
reporting, the largest number of patients are regis-
tered in Europe and North America. In the period
from 2004-2008, 201 cases in 2006, and up to 413
cases in 2004 were registered in our country [7].
For the period 2012-2022 covered by this study,
the following conclusions can be made:
• Salmonellosis in the Republic of North
Macedonia shows a decreasing tendency. This
tendency is because food operators and manu-
facturers observe the procedures of the HACCP
control system for food safety;
• In the period 2012-2022, the highest
number of patients (n=373) and the highest in-
cidence (18/100000) of salmonellosis were reg-
istered in 2018, and the lowest in 2020 (n=119,
I=5.8/100000);
• The dynamics index with a constant base
had the highest value in 2018 which is 152% com-
pared to the base of 2012 which is 100%. The
lowest value is in 2020, when it is 49% compared
to the base in 2012 (100%);
• In dynamic indexes with a variable base
(chain indexes), the salmonellosis index in 2015
was 171% compared to the index in 2014, which
was 78%. This is also the highest dynamic index
with a variable base. The index in 2020 has the
lowest value of the indexes with a variable base
(52%) in relation to the index in 2019, which is
61%;
• Thebiggestincreaseinsalmonellosisinthe
Republic of North Macedonia was in 2015, 71%
compared to 2014. While the biggest decrease in
salmonellosis in the Republic of North Macedonia
was in 2020 by 48% compared to 2019. Such a
result is on account of the COVID-19 pandemic.
At the height of the COVID-19 pandemic, all other
were neglected diseases and the health system was
fighting only against COVID-19.
REFERENCES
1. Taleski V., Angelovska B., Zdravkovska M. et
al.: Red infectious diarrheal diseases – the most
important bacterial causes (1), Pharmaceutical
Informator, 2015, 41: 41.
2. Movement of acute infectious diseases in the
Republic of North Macedonia in 2022, Depart-
ment of Epidemiology of Infectious Diseases,
Institute of Public Health of the Republic of
North Macedonia, Skopje, 2023, p. 18.
3. Stoilova S., Orovchanec N.: Biostatistics with
medical informatics, High Medical School, Bi-
tola, 2005, p. 51-54 and 58-60.
4. Mladenovska R., Brčina I.: Public health as-
pects of salmonellosis, 5th International sci-
entific-practical conference ECONOMIC
INTEGRATION AND REGIONAL DEVEL-
OPMENT - a collection of scientific reports,
Askoni-izdat, Sofia, 2022, p. 321-322.
5. Stojilković J., Trajchev M., Nakov D.: Presence
of Salmonella enteritidis in pasta with eggs,
KNOWLEDGE – international journal, Vol.
35.3, p. 916.
6. Toshev A.: The development tendency and cor-
relation dependence of infectious diseases and
the population in the Republic of Macedonia
and the environment and their influence on the
economic effects of organizations - master's the-
sis, "Goce Delchev" University, Faculty of Eco-
nomics, Shtip, 2011, p. 56.
7. Stoilova S.: Epidemiology, University of “St.
Kliment Ohridski", High Medical School, Bito-
la, 2010, p. 158-159.
55
INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA
Резиме
ИСПИТУВАЊЕ НА ДИНАМИКАТА НА САЛМОНЕЛОЗИТЕ
ВО РЕПУБЛИКА СЕВЕРНА МАКЕДОНИЈА
Бесим Мемеди1
и Влатко Таневски2
1
Колеџ ,,Резонанца“, Ветерник, Приштина, Р. Косово
2
ВТ диет клуб, ул. Јане Сандански број 15, Битола, Р. С. Македонија
Главните цели на ова истражување се да се утврди развојната тенденција на салмонелозите
во Република Северна Македонија и да се утврдат индексите на динамика и темпото на опаѓање/
покачување на салмонелозите во Република Северна Македонија. Истражувањето го опфаќа периодот
од 1.1.2012 год. до 31.12.2022 год. Податоците што се користени за спроведувањето на оваа студија
се добиени од Институтот за јавно здравје на Република Северна Македонија. Истражувањето оп-
фати 2711 испитаници заболени од салмонелоза во периодот од 2012 до 2022 год. Како статистички
методи на работа се употребени: линиски тренд, индекси на динамика со постојана база, индекси
на динамика со променлива база (синџирести индекси), темпо на опаѓање и темпо на покачување.
Резултатите од студијата сугерираат дека во периодот 2012–2022 год. најголем број заболени (n =
373) и највисока инциденца (18/100000) од салмонелози се регистрирани во 2018 година, а најнизок
во 2020 година (n = 119, I = 5,8/100000). Од вредностите на линискиот тренд може да се констатира
дека салмонелозите во Република Северна Македонија покажуваат тенденција на опаѓање. Најголем
пораст на салмонелозите во Република Северна Македонија имало во 2015 година за 71 % во однос
на 2014 година, додека најголемо опаѓање на салмонелозите во Република Северна Македонија имало
во 2020 година за 48 % во однос на 2019 година. Од студијата може да се заклучи дека операторите
и производителите на храна внимаваат на процедурите на контролниот систем за безбедност на
храната HACCP, поради што салмонелозите покажуваат тренд на опаѓање.
Клучни зборови: салмонелози, тренд, индекс, темпо, опаѓање, покачување

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Investigation-of-the-Dynamics-of-Salmonellosis-in-the-Republic-of-North-Macedonia.pdf

  • 1. MASA МАНУ CONTRIBUTIONS. Sec. of Med. Sci., XLIV 3, 2023 ПРИЛОЗИ. Одд. за мед. науки, XLIV 3, 2023 ISSN 1857-9345 ABSTRACT The main goals of this research are to determine the developmental tendency of salmonellosis in the Republic of North Macedonia and to determine the index of dynamics and the rate of decline/increase of salmonellosis in the Republic of North Macedonia. The research covers the period from 01.01.2012 until 31.12.2022. The data used to implement this study were obtained from the Institute of Public Health of the Republic of North Macedonia. The research included 2711 subjects who were sick with salmonellosis from 2012 to 2022. The following statistical methods of work are used: linear trend, dynamic index with a constant base, dynamic index with a variable base (chain index), rate of decline, and rate of increase. The results of the study suggest that in the period 2012-2022, the highest number of patients (n=373) and the highest incidence (18/100000) of salmonellosis were registered in 2018, and the lowest in 2020 (n=119, I=5.8/100000). From the linear trend values, it can be concluded that salmonellosis in the Republic of North Macedonia shows a decreasing tendency. The biggest increase in salmonellosis in the Republic of North Macedonia was in 2015 by 71% compared to 2014. The biggest decrease in salmonellosis in the Republic of North Macedonia was in 2020 by 48% compared to 2019. From the study, it can be concluded that food operators and manufacturers are observing the procedures of the HACCP control system for food safety, leading to a possible decrease in salmonellosis. Keywords:salmonellosis, trend, index, pace, decline, rise INTRODUCTION Corresponding author: Besim Memedi, besim.memedi@rezonanca-rks-com 1 "Resonance" College, Veternik, Pristina, R. Kosovo 2 VT diet club, Jane Sandanski St. 15, Bitola, R. N. Macedonia Besim Memedi1 and Vlatko Tanevski2 INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA Salmonella is the causative agent of intes- tinal typhus (Salmonella enterica serovar typhi), paratyphoid (Salmonella paratyphi A, B, C), or food poisoning (salmonellosis, alimentary tox- oinfections). Intestinal typhus is a severe, acute, infec- tious disease manifested by bacteremia, septice- mia, continuous high fever, hepatosplenomega- ly, and skin changes on the abdomen and chest. Paratyphoids (A, B, C) are similar to typhus, but have a much milder clinical picture. Patients may have constipation or diarrhea. Animals are the main reservoir for salmo- nella bacteria. Humans are the only carriers of ty- phoid salmonellas. These salmonella bacteria are transmittedthroughafecal-oraltransmissionmech- anism, with direct and indirect contact, through contaminated water, food (milk and dairy products, fruits, vegetables, shellfish), soil, and insects. Salmonellosis is caused by "atypical sal- monella bacteria" of which there are about 2500 serological types. The most significant and com- mon are Salmonella typhimurium and Salmonella enteritidis [1]. Salmonellosis can occur in two 10.2478/prilozi-2023-0046
  • 2. 50 Besim Memedi and Vlatko Tanevski clinical forms, acute enterocolitis (enteritis) and alimentary toxoinfection (acute gastroenteritis). It rarely causes septicemia with a clinical picture of typhus [7]. Alimentary toxoinfections are caused by "non-typhoidal salmonella bacteria" which have about 2500 serological types. The most significant and common are Salmonella typhimurium and Salmonella enteritidis. They cause acute infectious diseases that often occur in the form of epidemics. The dis- eases are manifested by nausea, vomiting, and diarrhea (watery or dysenteric in a smaller number of cases). They represent a risk for the elderly and children with reduced immunity. These diseases are zoonoses because the main reservoir and source of infection are do- mestic and wild animals (pigs, poultry, cattle, sheep, and rodents) [1]. The reservoir can be a sick, convalescent carrier, as well as asymptomatic cases, the so-called healthy germ carriers. Chronic germ carriers are rare in humans but are present in animals [7]. Salmonella bacteria are transmit- ted through contaminated food of animal origin (meat and eggs), and less often through water or contact [1]. GOALS The main objectives of this research are: • To determine the development tendency of salmonellosis in the Republic of North Mace- donia; • To determine the indexes of dynamics and the rate of decrease/increase of salmonellosis in the Republic of North Macedonia. MATERIAL AND METHODS Research material The focus of this research is to examine the dynamics of salmonellosis in the Republic of North Macedonia. The research was conducted by the College "Resonance" in R. Kosovo and VT diet club - Bitola, R. N. Macedonia. The re- search covers the period from 01.01.2012, until 31.12.2022. The research is of a retrospective type. The data we used to conduct this research was taken from the annual report on the move- ment of acute infectious diseases in the Republic of North Macedonia in 2022, which was issued by the Department of Epidemiology of Infectious Diseases at the Institute of Public Health of the Re- public of North Macedonia. The research included 2711 subjects who were sick with salmonellosis from 2012 to 2022. Research methodology The research included 2711 patients with salmonellosis from 2012 to 2022. To conduct this research, it was important to meet certain criteria: The study should include cases of salmo- nellosis; The study should include both sexes. Statistical method of data processing The following statistical methods were used: linear trend, dynamic indexes with a constant base, dynamic indexes with a variable base (chain indexes), rate of decline, and rate of increase. The data are presented tabularly and graphically. RESULTS Table 1 shows data on the number of pa- tients and the incidence of salmonellosis in the Republic of North Macedonia for the period from 2012 until 2022. The data was taken from the an- nual report on the Movement of acute infectious diseases in the Republic of North Macedonia in 2022, issued by the Department of Epidemiology of Infectious Diseases at the Institute of Public Health of the Republic of North Macedonia. Year Number of diseased I / 100000 2012 245 11.9 2013 262 12.7 2014 204 9.9 2015 348 16.8 2016 254 12.3 2017 317 15.3 2018 373 18 2019 228 11
  • 3. 51 INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA 2020 119 5.8 2021 194 9.4 2022 167 9.1 Table 1. Salmonellosis, number and I/100000, R. N. Macedonia, 2012-2022 From Table 1, it can be concluded that in the period 2012-2022, the highest number of patients (n=373) and the highest incidence (18/100000) of salmonellosis were registered in 2018, and the lowest in 2020 (n=119, I=5.8/100000) [2]. To determine the development tendency of salmonellosis in the Republic of North Macedo- nia, it is necessary to create a trend. There are several types of trends: linear, parabolic, logarith- mic, etc. The line trend is mostly used. It is made according to the formula: y = a + bx In the formula where y the trend value is expressed, a and b are trend coefficients, and with x, time is indicated. The value of the trend coeffi- cients is determined by the formulas: Table 2 shows the procedure for determin- ing a linear trend. In Table 2, the time values (X) are determined in such a way that the middle year (2017) in the analyzed period is marked with 0 (X=0). The values of (X) above zero are marked as: -1, -2, -3, -4, -5, and below zero 1, 2, 3, 4, 5. Y shows the individual frequencies of salmonellosis in the analyzed period. X ×Yshows the individual products, and when calculating the sum, attention should be paid to the negative sign. Year X Y X × Y X2 2012 -5 245 -1225 25 2013 -4 262 -1048 16 2014 -3 204 -612 9 2015 -2 348 -696 4 2016 -1 254 -254 1 2017 0 317 0 0 2018 1 373 373 1 2019 2 228 456 4 2020 3 119 357 9 2021 4 194 776 16 2022 5 167 835 25 ∑ 2711 -1038 110 Table 2. Salmonellosis in the Republic of North Macedonia 2012-2022 By replacing the corresponding values, the values of the trend coefficients, as well as the trend itself, are determined: y = a + bx = 246.45 – 9.44 x In further elaboration, trend values for each year are determined (Table 3). Year y = a + bx = 246.45-9.44x 2012 291.45 2013 282.45 2014 273.45 2015 264.45 2016 255.45 2017 246.45 2018 237.45 2019 228.45 2020 219.45 2021 210.45 2022 201.45 2023 189.81 2024 180.37 2025 170.93 Table 3. Determination of trend values for salmonellosis in the Republic of North Macedonia The obtained individual trend values in the examined period are applied in a coordinate sys- tem (Graph 1).
  • 4. 52 Besim Memedi and Vlatko Tanevski From Graph 1, it can be seen that salmonel- losis in the Republic of North Macedonia shows a decreasing tendency. For the years 2023, 2024, and 2025, a fore- cast was made for the trend values (only the values for time X are changed in the trend formula), and it can be seen that even in the years of the forecast salmonellosis shows a tendency to decline. Dynamics indexes allow the analyzed phe- nomena to be seen as relative variations over time. There are two types of momentum indexes: con- stant-base momentum indexes and variable-base momentum indexes (chain indexes). In dynamic indexes with a constant base, the base can be the smallest or largest number in a time series, that is, it can be the average value as in this study. Once the base is determined, the time series data is brought into relation with the base, expressed as a percentage. A disadvantage of constant-base indexes is that adjacent dynamic indexes cannot be compared. The comparison is always with the base (Table 4). Dynamic indexes with a variable base (chain indexes) are determined in such a way that the frequency (number, value) of the analyzed phenomenon for the corresponding year is divided by the frequency of the previous year. Dynamic indexes with a variable base allow mutual com- parison of the values for each year of the time series (Table 4). Graph 1. Salmonellosis in the Republic of North Macedonia, trend, 2012-2022 Year Number of diseased Indexes Permanent base Variable base 2012 245 100% ∕ 2013 262 107% 107% 2014 204 83% 78% 2015 348 142% 171% 2016 254 104% 73% 2017 317 129% 125% 2018 373 152% 118% 2019 228 93% 61% 2020 119 49% 52% 2021 194 79% 163% 2022 167 68% 86% Table 4. Dynamic Indexes / Salmonellosis in the Republic of North Macedonia 2012 - 2022. Table 4 shows that the index of dynamics with a constant base is highest in 2018 when it is 152%, compared to the base in 2012 which is 100%. The lowest value is in 2020, when it is 49% compared to the base in 2012 (100%). In dynamic indexes with a variable base (chain indexes), the salmonellosis index in 2015 was 171% compared to the index in 2014, which was 78%. This is also the highest dynamic index with a variable base. The index in 2020 has the lowest value of the indexes with a variable base (52%) compared to the index in 2019, which is 61%.
  • 5. 53 INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA Looking at Table 4, it is possible to deter- mine the decrease or increase of salmonellosis in the Republic of North Macedonia during any interval of the analyzed period (2012-2022). In this study, the rate of increase for 2014-2015 has been determined, because this period presented the greatest increase in salmonellosis in the Republic of North Macedonia. Also, the rate of decline is calculated for the period 2019-2020, in which the most significant decline of salmonellosis is record- ed in the Republic of North Macedonia (Table 5). Rate of decrease Rate of increase 2019 228 2014 204 2020 119 2015 348 Decrease 48% Increase 71% Table 5. Rate of decrease and rate of increase / Salmonellosis in the Republic of North Macedonia 2012 - 2022. From Table 5, it can be concluded that the rate of decrease in salmonellosis in 2020 is 48%, and the rate of increase (growth) in salmonellosis in 2015 is 71% compared to 2014 [3]. DISCUSSION Because the Salmonella spp. bacteria easily reproduce in food without changing their organo- leptic properties, the population, when consuming food, often does not even assume that they have already been poisoned by it. Therefore, bacterio- logical monitoring of salmonellas has a preven- tive role for infectious diseases transmitted by unsafe food. A retrospective study covering the period from 2016 to 2020 found that Salmonella spp. is in first place among the total number of detected bacteria in the examined samples in the microbiological laboratory at CPHS (Center for Public Health - Skopje). In the investigated five- year period in the bacteriological analysis of food samples, Salmonella spp. was detected 24.4% of the time. Of the total number of 7094 salmonel- las detected in food samples from imports, 6.9% are accounted for, while 93.1% are from domes- tic production. In the total number of samples taken for bacteriological examination according to bacteria in the trade and domestic production, artisanal production participates with 69.3%. The percentage of defective samples of Salmonella spp. in the researched period amounts to only 3, or they range from 0.06% in 2016 to 0.10% in 2020. In trade and domestic production, all three defective samples were detected, and in craft pro- duction, there were two defective samples and one sample in 2016 came from industrial production. In conclusion, during the five-year analysis of food samples received for bacteriological exam- ination of the most common groups of bacteria that appear in the unsafe samples during the an- alyzed period, which were examined in the bac- teriological laboratory at the CPHS, Salmonella spp. is in first place, followed by Escherichia coli, the total number of Enterobacteriaceae species, molds, yeasts, and other bacteria. The percentage of defective samples of the aforementioned bac- teria is insignificant and it indicates that the food consumed is safe for consumers and that the op- erators and manufacturers observe the procedures of the HACCP food safety control system [4]. It is thought that in the year 2000, at least 2 million people worldwide died from diarrhea caused by bacteria from the genus Salmonella. In the United States of America, salmonellosis is the cause of approximately 1.3 million foodborne illnesses, with approximately 15,000 hospital- izations and 500 deaths annually, accounting for 15.1% of incidences followed by campylobacte- riosis (13.8%) and shigellosis (Schroeder, 2005). According to the reports of the European Food SafetyAgency (EFSA, 2012), Salmonella enteriti- dis was isolated in 41.3% of the confirmed cases of salmonellosis in people from the European Union countries. The research of Papadopoulos et al. (2016) determined that the strains of Salmonella eneritis circulating through the food chain match the serotype profiles of Salmonella enteritidis in Europe. In the Republic of Serbia, Salmonella enteritidis was the most frequently isolated Sal- monella serotype from food products, although Salmonella typhimurium was also rarely isolated (Rašeta et al, 2014).According to research by Pav- lović, Maris, Zlatar & Purtić-Klajić (2014), in the period from 2011 to 2013 in the territory of the city of Belgrade, the share of salmonellosis was 80.4% of all recorded alimentary epidemics. Cakes and sweets (22.2%), eggs (8.9%), and roasted chicken meat (4.4%) were determined as the most common source of salmonellosis epidemics. This is sup- ported by the research of Ban, Vodopija Petrović & Matica (2011), who, studying the epidemiology of salmonellosis in the Republic of Croatia in the period 1990-2009, determined that the most fre- quently isolated serotype of Salmonella, as much as 84%, was Salmonella enteritidis.According to the same authors, in 32% of the cases, infected
  • 6. 54 Besim Memedi and Vlatko Tanevski eggs were the source of infection, and in 10%, poultry. In these epidemics, as a source of sal- monellosis, the share of pasta was no less (10%). Ivić-Kolevska & Kocić (2009) determined that in the period from 2003 to 2005, as well as in 2006 and 2007, the most common source of salmonella in our country was chicken meat, but also milk, dairy products, and some types of sweets [5]. Salmonellosis in the Republic of North Macedonia in the period from 2012 to 2022 shows a decreasing tendency due to the following factors: improved water quality, more frequent control of sanitary-hygienic inspection in enterprises where food products are produced, stored, transported, and consumed, the way of eating, hygiene, as well solutions to ban facilities, thus cutting the chain of infection [6]. The biggest decrease in salmonel- losis in the Republic of North Macedonia was in 2020 by 48% compared to 2019. This can be the result of the COVID-19 pandemic.At the height of the COVID-19 pandemic, all other diseases were neglected, and the fight was directed only against COVID-19 within the health system. CONCLUSION Salmonellosis are diseases that are found all over the world. Due to better registration and reporting, the largest number of patients are regis- tered in Europe and North America. In the period from 2004-2008, 201 cases in 2006, and up to 413 cases in 2004 were registered in our country [7]. For the period 2012-2022 covered by this study, the following conclusions can be made: • Salmonellosis in the Republic of North Macedonia shows a decreasing tendency. This tendency is because food operators and manu- facturers observe the procedures of the HACCP control system for food safety; • In the period 2012-2022, the highest number of patients (n=373) and the highest in- cidence (18/100000) of salmonellosis were reg- istered in 2018, and the lowest in 2020 (n=119, I=5.8/100000); • The dynamics index with a constant base had the highest value in 2018 which is 152% com- pared to the base of 2012 which is 100%. The lowest value is in 2020, when it is 49% compared to the base in 2012 (100%); • In dynamic indexes with a variable base (chain indexes), the salmonellosis index in 2015 was 171% compared to the index in 2014, which was 78%. This is also the highest dynamic index with a variable base. The index in 2020 has the lowest value of the indexes with a variable base (52%) in relation to the index in 2019, which is 61%; • Thebiggestincreaseinsalmonellosisinthe Republic of North Macedonia was in 2015, 71% compared to 2014. While the biggest decrease in salmonellosis in the Republic of North Macedonia was in 2020 by 48% compared to 2019. Such a result is on account of the COVID-19 pandemic. At the height of the COVID-19 pandemic, all other were neglected diseases and the health system was fighting only against COVID-19. REFERENCES 1. Taleski V., Angelovska B., Zdravkovska M. et al.: Red infectious diarrheal diseases – the most important bacterial causes (1), Pharmaceutical Informator, 2015, 41: 41. 2. Movement of acute infectious diseases in the Republic of North Macedonia in 2022, Depart- ment of Epidemiology of Infectious Diseases, Institute of Public Health of the Republic of North Macedonia, Skopje, 2023, p. 18. 3. Stoilova S., Orovchanec N.: Biostatistics with medical informatics, High Medical School, Bi- tola, 2005, p. 51-54 and 58-60. 4. Mladenovska R., Brčina I.: Public health as- pects of salmonellosis, 5th International sci- entific-practical conference ECONOMIC INTEGRATION AND REGIONAL DEVEL- OPMENT - a collection of scientific reports, Askoni-izdat, Sofia, 2022, p. 321-322. 5. Stojilković J., Trajchev M., Nakov D.: Presence of Salmonella enteritidis in pasta with eggs, KNOWLEDGE – international journal, Vol. 35.3, p. 916. 6. Toshev A.: The development tendency and cor- relation dependence of infectious diseases and the population in the Republic of Macedonia and the environment and their influence on the economic effects of organizations - master's the- sis, "Goce Delchev" University, Faculty of Eco- nomics, Shtip, 2011, p. 56. 7. Stoilova S.: Epidemiology, University of “St. Kliment Ohridski", High Medical School, Bito- la, 2010, p. 158-159.
  • 7. 55 INVESTIGATION OF THE DYNAMICS OF SALMONELLOSIS IN THE REPUBLIC OF NORTH MACEDONIA Резиме ИСПИТУВАЊЕ НА ДИНАМИКАТА НА САЛМОНЕЛОЗИТЕ ВО РЕПУБЛИКА СЕВЕРНА МАКЕДОНИЈА Бесим Мемеди1 и Влатко Таневски2 1 Колеџ ,,Резонанца“, Ветерник, Приштина, Р. Косово 2 ВТ диет клуб, ул. Јане Сандански број 15, Битола, Р. С. Македонија Главните цели на ова истражување се да се утврди развојната тенденција на салмонелозите во Република Северна Македонија и да се утврдат индексите на динамика и темпото на опаѓање/ покачување на салмонелозите во Република Северна Македонија. Истражувањето го опфаќа периодот од 1.1.2012 год. до 31.12.2022 год. Податоците што се користени за спроведувањето на оваа студија се добиени од Институтот за јавно здравје на Република Северна Македонија. Истражувањето оп- фати 2711 испитаници заболени од салмонелоза во периодот од 2012 до 2022 год. Како статистички методи на работа се употребени: линиски тренд, индекси на динамика со постојана база, индекси на динамика со променлива база (синџирести индекси), темпо на опаѓање и темпо на покачување. Резултатите од студијата сугерираат дека во периодот 2012–2022 год. најголем број заболени (n = 373) и највисока инциденца (18/100000) од салмонелози се регистрирани во 2018 година, а најнизок во 2020 година (n = 119, I = 5,8/100000). Од вредностите на линискиот тренд може да се констатира дека салмонелозите во Република Северна Македонија покажуваат тенденција на опаѓање. Најголем пораст на салмонелозите во Република Северна Македонија имало во 2015 година за 71 % во однос на 2014 година, додека најголемо опаѓање на салмонелозите во Република Северна Македонија имало во 2020 година за 48 % во однос на 2019 година. Од студијата може да се заклучи дека операторите и производителите на храна внимаваат на процедурите на контролниот систем за безбедност на храната HACCP, поради што салмонелозите покажуваат тренд на опаѓање. Клучни зборови: салмонелози, тренд, индекс, темпо, опаѓање, покачување