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Introduction/Objective Vaccination against seasonal influenza is the most effective way to prevent infections, hospitalization, morbidity and mortality. The objective of the study was to assess the knowledge, attitude and practices of the North Macedonia adult population towards seasonal influenza vaccine Methods A prospective cross-sectional study in November-December 2022 among the adult population of North Macedonia was conducted. A total of 1012 respondents filled in the 4-item semi-structured questionnaire. The questionnaire collected information on demographics, knowledge, attitudes, and practices towards the influenza vaccine. The chi-square test was used to test for associations and logistic regression was used to determine the effect of variables on the possibility of vaccination. Results The median age of the respondents was 36 years, predominantly female (73.5%). Only 7.8% of respondents received the influenza vaccine in the previous season (2021/2022) and 12.4% planned to vaccinate in the current season. A statistically significant difference between the vaccinated and non-vaccinated individuals was established in terms of age groups and the presence of comorbidity (χ2 = 11.246, p = 0.004). The main source of information for vaccinated respondents were official sources such as MH, WHO, and CDC for information about the influenza vaccine compared to non-vaccinated (χ2 = 8.099, p = 0.004). The vaccinated respondents significantly more often tend to consider the influenza vaccine as safe (χ2 = 5.026, p = 0.025) and effective (χ2 = 11.247, p = 0.001). Respondents who had comorbidities, who considered the vaccine as effective were 3 times and 1.9 times more likely respectively to have received an influenza vaccine. Conclusion The study discovered that in North Macedonia the coverage with influenza vaccine is low. Addressing influenza vaccine safety, efficacy, patient-specific recommendations and encouraging effective physician communication and counselling are some of the key areas for increasing knowledge and awareness.