Auditable Context-Aware HFMD Forecasting with Structured LLM Agents

Abstract

Effective HFMD surveillance requires forecasts capturing both time-series patterns and contextual drivers such as school calendars, weather, and policy or surveillance reports. In clinical settings, forecasts must be trusted and actionable; thus, beyond point accuracy, decision-makers require concise, auditable explanations of why risk is expected to rise or fall. Classical models (e.g., ARIMA and Prophet) and foundation models (e.g., Chronos, Moirai, and TimesFM) treat external covariates as numerical inputs, lacking semantic reasoning to reflect epidemiological mechanisms or resolve conflicting signals. We propose a two-agent neuro-symbolic framework that decouples contextual interpretation from probabilistic forecasting. An LLM-based Event Interpreter ingests heterogeneous signals -- school schedules, weather summaries, government reports, and clinical guidelines -- and outputs a scalar transmission-impact signal. A Forecast Generator combines this signal with historical case counts to produce point forecasts that are mapped to probabilistic predictions through Poisson/negative-binomial moment matching. We focus on one-week-ahead rolling forecasts, aligning with weekly hospital-capacity planning and the rapid, context-driven inflections typical of HFMD. We evaluate on two datasets: Hong Kong surveillance (90 target weeks in 2023--2024) and Lishui hospital visits (33 target weeks in 2024). Against traditional and foundation-model baselines, our approach achieves competitive point accuracy while providing robust 90\% intervals (coverage approximately 0.85--1.00) and concise rationales. This demonstrates that integrating domain knowledge through LLM-based agents can match strong numerical forecasters while yielding interpretable, context-aware forecasts aligned with public-health decision-making.