With its rapid urbanization and development as well as high diversity of animal species, Southern China is facing major social and ecological changes that result in human and animal interactions favoring the emergence of zoonotic diseases. In order to identify the zoonotic risks from human-animal interactions and develop a risk-mitigation strategy, concurrent surveillance was conducted in bat and human communities in southern China from 2015 to 2017.

Data were collected in 88 semi-structured ethnographic interviews as an exploratory study, followed by serological and quantitative questionnaire surveillance among 1,596 residents in locations where potential human-animal interactions were identified. Questionnaires were administered and participants were asked to provide serum samples. Viral surveillance in bat populations was conducted at the same locations and during the same period as the human surveys to maximize the understanding of pathogen transmission from bats to humans. Laboratory testing was conducted for bat coronaviruses with RT-PCR and developed ELISA assays, and a mixed method was employed to analyze the qualitative and quantitative human data.

This study demonstrates the first serological evidence of the spill-over of bat-origin coronaviruses into human populations in southern China, identifies demographic factors and human-animal interactions associated with viral exposure and self-reported severe acute respiratory and influenza-like illness symptoms known to occur with coronavirus infection. Combining existing protective factors and intervention opportunities, individual, social, community, and policy-level mitigation strategies are recommended to prevent zoonotic risk in Southern China.