Introduction Rationale for guideline updateSix years after the Southern African HIV Clinicians Society cryptococcal disease guideline was published in 2013, cryptococcal meningitis (CM) remains an important cause of mortality among antiretroviral treatment (ART)-naïve and ART-experienced HIV-seropositive adults in South Africa. 1,2 Several important practice-changing developments led us to update the guideline to diagnose, prevent and manage this common fungal opportunistic infection. The World Health Organization (WHO) published a guideline for advanced HIV disease in 2017 and a guideline relevant to resource-limited settings for HIV-associated CM in 2018. 3,4 Cryptococcal antigen (CrAg) screening and pre-emptive treatment reduced all-cause mortality among ambulatory participants in a randomised clinical trial in Zambia and Uganda. 5 Following an evaluation of reflex versus provider-initiated screening, national reflex laboratory CrAg screening was implemented in South Africa in 2016. 6,7 Recently completed clinical trials conducted in resourcelimited settings have provided evidence for the best first-line antifungal regimens for CM and the

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the World Health Organization reported the emergence of an outbreak of pneumonia cases in Wuhan, China. The disease was later termed coronavirus disease 2019 and the causative agent was identified as a novel coronavirus, SARS-CoV-2. [1] The first case of COVID-19 in South Africa (SA) was announced on 5 March 2020, and a cumulative total of ~1.5 million confirmed cases and 50 000 deaths had been recorded by 7 March 2021. [2,3] The COVID-19 vaccination roll-out for healthcare workers (phase 1) was planned for February 2021 using the Oxford AstraZeneca vaccine. [4,5] However, concerns arose about the efficacy of COVID-19 vaccine candidates in the context of dominance of the B.1.351 variant, as it contained mutations at the receptor-binding domain of the virus, the target site of many vaccines. [6,7] Further data analysis revealed that a two-dose regimen of the AstraZeneca ChAdOx1 nCoV-19 vaccine had an efficacy of 10.4% against mild to moderate COVID-19 caused by the B.1.351 variant. [8] In contrast, interim analysis of the single-dose Johnson & Johnson/Janssen Ad26.COV2.S vaccine (J&J) demonstrated 57% protection against the B.1.351 lineage of SARS-CoV-2 and complete protection against COVID-19 hospitalisation and death. [9] These findings led to a public announcement on 7 February 2021 that healthcare workers would be vaccinated through an implementation study using the J&J vaccine, under the name Sisonke Early Access Vaccine Rollout for Healthcare Workers. [10,11] A core vaccine team was formed at Chris Hani Baragwanath Academic Hospital (CHBAH) on 13 January 2021. CHBAH is the largest hospital in the southern hemisphere and the third-largest in the world, with a bed capacity of 3 200 beds and a staff complement of ~7 400. [12] The facility is located in Soweto, a peri-urban town 27 km south-west of Johannesburg in the most populous province of the country, Gauteng. [12] The hospital serves a population of >1.3 million people, and offers a full range of generalised specialist and subspecialist services. [12] The vaccine team planned for a 'mass vaccination' roll-out of staff on the launch date, 17 February 2021. Mass vaccination strategies are considered to be most useful in pandemic situations, as they allow for the fast and efficient vaccination of a large number of susceptible people, using a central vaccination site. [13] The benefits of mass vaccination of healthcare worker programmes over ward-toward-based vaccination programmes are: (i) a streamlined process for pharmacy vaccine delivery, preparation and secure storage, while also ensuring that the cold chain is maintained; (ii) easy access to an emergency care team that remains in the vaccination site in the event of adverse events following immunisation (AEFIs); and (iii) a centrally controlled data capture system. Disadvantages include the need for a large number of staff to support the mass vaccination process itself, requiring precision and careful planning. [14,15] There is a paucity of peer-reviewed literature on the implementation of mass vaccinat...

From April to September 2020, we investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in a cohort of 396 healthcare workers (HCWs) from 5 departments at Chris Hani Baragwanath Hospital, South Africa. Overall, 34.6% of HCWs had polymerase chain reaction–confirmed SARS-CoV-2 infection (132.1 [95% confidence interval, 111.8–156.2] infections per 1000 person-months); an additional 27 infections were identified by serology. HCWs in the internal medicine department had the highest rate of infection (61.7%). Among polymerase chain reaction–confirmed cases, 10.4% remained asymptomatic, 30.4% were presymptomatic, and 59.3% were symptomatic.