Nine new confirmed cases were reported from 15 to 21 January in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo.

On 20 January 2020, National IHR Focal Point (NFP) for Republic of Korea reported the first case of novel coronavirus in the Republic of Korea. The case is a 35-year-old female, Chinese national, residing in Wuhan, Hubei province in China.

The case-patient had developed fever, chill, and muscle pain on 18 January while in Wuhan. She visited a local hospital in Wuhan and was initially diagnosed with a cold. On 19 January , the case-patient was detected with fever (38.3 °C) upon arrival at the Incheon International Airport. The case-patient was transferred to a national designated isolation hospital for testing and treatment. She was tested positive for pancoronavirus reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and subsequently was confirmed positive for novel coronavirus (2019-nCoV) on 20 January by sequencing at the Korea Centers for Disease Control and Prevention (KCDC). Upon detection, the patient had chills, runny nose, and muscle pain.

On 15 January 2020, the Ministry of Health, Labour and Welfare, Japan (MHLW) reported an imported case of laboratory-confirmed 2019-novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.

The case-patient is male, between the age of 30-39 years, living in Japan.

A 67-year-old Caucasian man, an avid traveler with a history of hypertension, depression, and previous morbid obesity treated with bariatric surgery, presented with low-grade fever and recurrent left-ankle painful rash (Figure 1A). The patient noted the first episode 2 months prior to presentation when he presented with a poorly defined painful erythematous patch over his left ankle and leukocytosis. He was treated with cefazolin for suspected cellulitis and discharged on cephalexin with partial improvement. Infectious workup, including blood cultures, echocardiogram, and x-ray, was negative. Over the next few weeks he developed similar discrete episodes with new, noncontiguous rashes to other body parts, such as the abdomen, left shoulder (Figure 1B), right gluteal region, right elbow, and left knee that spontaneously resolved within a few days, sometimes without antibiotic treatment. A partial response to antihistamines, leg elevation, and doxycycline was noted, but rash and pain worsened with a short trial of steroids after initial improvement. Two days prior to admission, he again developed left-ankle painful erythematous rash spreading up to his knee, associated with fever. He had an extensive travel history with trips to China, India, South Asia, Canada, and Brazil in the last decade. Five months previously he had visited Hong Kong where he had a diarrheal illness consisting of 4–5 loose but not watery stools for 2 days that self-resolved. Three months previously he visited Morocco where he rode a camel. He lives in Missouri and has retired but volunteers with refugees hailing from the developing world receiving treatment for tuberculosis. He is a former sushi chef and eats raw seafood often. On presentation, he was febrile to 38.3°C but otherwise had stable vital signs. Laboratory data revealed leukocytosis (12 300 cells/μL) and elevated erythrocyte sedimentation rate (49 mm/h) and C-reactive protein (103 mg/L). Blood cultures were collected, and the patient was started on vancomycin and cefepime. Rheumatologic testing was negative, as was testing for syphilis, human immunodeficiency virus, tuberculosis, and Lyme disease. Left lower extremity computed tomography showed superficial soft tissue edema without osteomyelitis or abscess. Echocardiogram showed normal ventricular function without vegetations. Skin biopsy revealed sparse perivascular and interstitial inflammatory infiltrate consistent with cellulitis with negative tissue bacterial cultures. The aerobic bottle from 2 sets of blood cultures obtained on the day of admission yielded a pathogen whose microscopic features are shown in Figures 2 and 3.