# Use of the Chainchecker application: Uganda’s experience during the 2022 Sudan Virus Disease outbreak

## TL;DR

Uganda used the Chainchecker app during a 2022 Sudan Virus Disease outbreak to track and correct transmission chains, improving outbreak control.

## Contribution

The paper introduces the practical use of Chainchecker for real-time visualization and correction of disease transmission chains during outbreaks.

## Key findings

- Chainchecker connected 11 previously unlinked cases to the main transmission chain.
- The app identified and corrected errors in 13 cases and found 5 potential nosocomial transmissions.
- The use of Chainchecker improved outbreak response and is recommended for EBOD preparedness.

## Abstract

On September 20, 2022, the Uganda Ministry of Health declared an outbreak of Sudan Virus Disease (SVD). As the outbreak grew, it became imperative to quickly visualize and analyze chains of disease transmission. Determining epidemiological links between cases is critical for outbreak control as incorrect linkages may result in missed case detection and undetected disease transmission. We describe the Uganda Ministry of Health’s experience using Chainchecker, a computer application designed to visualize and verify transmission chain data. To use Chainchecker, a line list documenting the epidemiological details associated with individual cases is uploaded to the application. To verify epidemiologic linkages, the application calculates the exposure windows for each case based on user-defined incubation periods and dates of symptom onset. If genetic sequencing data is available, Chainchecker can overlay genetic distance data on top of the epidemiologic data. Chainchecker can also provide visualizations of hospitalization data, which can highlight potential instances of nosocomial disease transmission. Using the Chainchecker application, the case investigation team was able to connect 11 previously unlinked cases to the larger chain of disease transmission. The use of the application also led to the identification and correction of transmission chain errors for 13 SVD cases and the identification of 5 potential instances of nosocomial transmission. The use of the Chainchecker application in Uganda during the 2022 SVD outbreak allowed the response teams to rectify critical errors in transmission chains. Countries prone to Ebola Disease (EBOD) outbreaks should consider incorporating Chainchecker as an element of EBOD preparedness and response.