Identifying factors that may improve mechanistic forecasting models for influenza

Abstract

Influenza causes substantial morbidity and mortality and places strain on healthcare systems, some of which could be mitigated by accurate forecasting. Specific humidity and school vacations have both been shown independently to affect the transmission dynamics of influenza at large spatial scales. Here, we compare the ability of five compartmental transmission models, which include these two processes, to explain influenza-like-illness (ILI) incidence data for five United States counties for which school vacations and specific humidity data were available over a span of four seasons. We used the models in two different ways. First we fitted all available data at the same time and assessed model performance using standard measures of parsimony and goodness-of-fit. Then we conducted a retrospective forecasting study in which we attempted to predict incidence beyond a given week by fitting to data available up to that week. In general, when fitting the data using the whole season, we found that either specific humidity, school closures, or a combined model incorporating both effects captured the variability in incidence better than a fully constrained SIR-like model. Moreover, where these factors play a role, the timing of the variations suggests a causal relationship. When school vacations and specific humidity were important, the model-estimated parameters were broadly consistent. Retrospective forecasting simulations were consistent with the explanatory use of the models, with both specific humidity and school vacations giving more accurate forecasts than a simple SIR-like model in some populations and for some seasons. Our results suggest that influenza forecast models should test for the importance of different factors such as school vacations and specific humidity on a population-by-population and year-by-year basis.\n\nAuthor summaryUnderstanding the underlying factors that contribute to the transmission of influenza is crucial for developing models with predictive capabilities. In this study, we address two key effects: humidity and school vacations. We show that both can play an important role, depending on the location of the population as well as the timing of the school vacations. We then demonstrate how such mechanistic models can be used to forecast an influenza season as it unfolds, including estimates of the uncertainty of the predictions at each week of the forecast. To make better influenza forecasts, models need to test whether factors such as school vacations and specific humidity are important for a given season and population.