Zoonotic diseases continue to present health, social, and economic challenges in China. While the country has demonstrated strong outbreak response capabilities, current efforts remain reactive and top-down. Shifting toward primary prevention at the human–animal–environment interface with enhanced risk communication offers a more sustainable approach to reducing zoonotic disease risks. This review synthesized peer-reviewed and gray literature in English and Chinese to characterize human–animal contact behaviors associated with 93 zoonotic diseases monitored by China’s public health, agricultural, and forestry sectors. It examined contact pathways across key animal groups known to carry zoonotic pathogens, identified human populations at risk, and analyzed the demographic, socio-cultural, and ecological factors shaping these contacts. Focusing on four major human–animal interfaces, the review further identified lessons and best practices for effective risk communications. Findings reveal that human–animal contact in China is diverse and embedded in daily routines, cultural practices, and economic activities, with distinct risk profiles presented across animal groups and socio-ecological settings. Populations such as smallholder farmers, herders, rural residents, market vendors, and workers in informal sectors face higher exposure risk, influenced by socio-economic conditions and ecological changes. Gaps remain in surveillance of informal practices, emerging pathogens, and behavioral data. Evidence from global and local experiences highlights the value of behavior-centered, community-engaged communication grounded in One Health principles, emphasizing participatory design, culturally relevant education, local leadership, and integration with public service systems. Overall, this review provides an integrated understanding of zoonotic disease risks and prevention opportunities from social-behavioral and communication perspectives. It identified priority populations, settings, and best practices for targeted and effective strategies, underscoring the need for coordinated One Health efforts to address complex human–animal–environment interactions and promote proactive zoonotic disease prevention in China and beyond.

Background

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL E. coli) from broiler chicken production pose potential public health risks via multiple environmental and foodborne pathways. We developed a modular quantitative microbial risk assessment (QMRA) model linking four components, namely farm, soil, river, and lettuce consumption, to predict human environmental exposure to ESBL E. coli originating from broiler flocks.

Methods

A stochastic farm module simulated broiler colonization over a 36-day cycle and generated end-cycle litter loads. Field modules represented first-order decay, partitioning, and runoff to rivers; irrigation transfer yielded lettuce contamination for a 100 g serving. We estimated exposure, mapped gastrointestinal colonization to urinary tract infection (UTI) via conditional probabilities, and expressed the burden as disability-adjusted life years (DALYs) per serving. Global sensitivity analyses identified main exposure drivers. Environmental time was indexed as days since litter application and the planting interval denoted days from litter application to planting.

Results

The farm model produced mean end-cycle litter of 1.6 × 10⁴ CFU/g and near-complete flock colonization within one week. Soil surface loads declined from 3.2 × 10⁷ CFU/m² to 8.6 × 10⁵ CFU/m² by day 100. Runoff yielded river concentrations of 6.0 × 10⁻² CFU/mL after 10 days. Exposure from lettuce consumption ranged from 1.7 CFU/100 g to 7.6 × 10⁻³ CFU/100 g; simple household washing cut exposure by ∼90 %. Global sensitivity analysis identified soil-water partitioning and decay rates as the most important parameters of exposure variability. For health endpoints, UTI risk per serving ranged from 4.6 × 10⁻¹² to 9.0 × 10⁻⁹, and DALY per serving ranged between 10⁻¹⁰ and 10⁻⁸.

Conclusions

Predicted health burdens decreased markedly with consumer washing and longer intervals between litter application and lettuce planting. Residual contamination persists, indicating value in evaluating the effectiveness of manure treatments and irrigation-water quality interventions on reducing environmental loads and human risk.

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