A prospective real-time transfer learning approach to estimate influenza hospitalizations with limited data

Accurate, real-time forecasts of influenza hospitalizations would facilitate prospective resource allocation and public health preparedness. State-of-the-art machine learning methods are a promising approach to produce such forecasts, but they require extensive historical data to be properly trained. Unfortunately, data on influenza hospitalizations, for the 50 states in the United States, are only available since the beginning of 2020. In addition, the data are far from perfect as they were under-reported for several months before health systems began consistently submitting their data. To address these issues, we propose a transfer learning approach. We extend the currently available two-season dataset for state-level influenza hospitalizations by an additional ten seasons. Our method leverages influenza-like illness (ILI) data to infer historical estimates of influenza hospitalizations. This data augmentation enables the implementation of advanced machine learning techniques, multi-horizon training, and an ensemble of models to improve hospitalization forecasts. We evaluated the performance of our machine learning approaches by prospectively producing forecasts for future weeks and submitting them in real time to the Centers for Disease Control and Prevention FluSight challenges during two seasons: 2022-2023 and 2023-2024. Our methodology demonstrated good accuracy and reliability, achieving a fourth place finish (among 20 participating teams) in the 2022-23 and a second place finish (among 20 participating teams) in the 2023-24 CDC FluSight challenges. Our findings highlight the utility of data augmentation and knowledge transfer in the application of machine learning models to public health surveillance where only limited historical data is available.