An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region.

Background: Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. Methods: We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. Findings: We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. Interpretation: While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

A scoping review on laboratory surveillance in the WHO Southeast Asia Region: Past, present and the future.

Background: The South-East Asia (SEA) region bears a significant proportion of the world's communicable disease burden. The onset of the COVID-19 pandemic has further affected the situation. A well-established laboratory-based surveillance (LBS) can reduce the burden of infectious diseases. In light of this, the review collated the existing literature on LBS system in the region and the modifications adopted by the surveillance systems during the pandemic. Methodology: We followed the guidelines for scoping review as prescribed by Arskey and O'Malley. We comprehensively searched three databases (PubMed, Scopus and CINAHL) and supplemented it with grey literature search. The screening of the articles was conducted at the title and abstract followed by full-text screening. This was followed by data extraction using a pre-tested data extraction tool by two independent reviewers. The results were presented narratively. Results: Including 75 relevant articles and documents, we compiled a list of surveillance systems. A shift from paper to dual (paper and electronic) modalities was identified across the countries. This largely low- and middle-income countries (LMIC) area face challenges in reporting, resources, and collaboration-related issues. While some countries have well-established National Reference Laboratories; others have more private than public-owned laboratories. Given the COVID-19 pandemic, modifications to the existing laboratory capacities to enable real-time surveillance was identified. Laboratory capacity complemented with genomic surveillance can indubitably aid in disease detection and control. Limitations due to inaccessible government portals, and language barriers are acknowledged. This review identified a comprehensive list of surveillance systems in the region, challenges faced in using these surveillance systems and inform the decision makers about the benefits of integrating fragmented surveillance systems. Conclusion: Regionally and nationally integrated genomic and laboratory surveillance systems justify capital investments, as their payoffs rationalise such costs owing to economies of scale over time. Further, as data flows are harmonized and standardized, algorithm- and computing-based pattern recognition methods allow for targeted and accurate disease prediction when integrated with, potentially, climate and weather systems data. Trained human resources are a sine qua non to optimize such investments, but in the medium to long run, such investments will buttress initiatives in other arenas at the regional level.

Battling against the great disruption to surgical care in a pandemic: experiences of 11 South and Southeast Asian countries.

OBJECTIVES: The majority of the cancelled elective surgeries caused by the COVID-19 pandemic globally were estimated to occur in low- and middle-income countries (LMICs), where surgical services had long been in short supply even before the pandemic. Therefore, minimising disruption to existing surgical care in LMICs is of crucial importance during a pandemic. This study aimed to explore contributory factors to the continuity of surgical care in LMICs in the face of a pandemic. DESIGN: Semistructured interviews were conducted over zoom with surgical leaders of 25 tertiary hospitals from 11 LMICs in South and Southeast Asia in September to October 2020. Key themes were subsequently identified from the interview transcripts using the Braun and Clarke's method of thematic analysis. RESULTS: The COVID-19 pandemic affected all surgical services of participating institutions to varying degrees. Overall, elective surgeries suffered the gravest disruption, followed by outpatient surgical care, and finally emergency surgeries. Keeping healthcare workers safe and striving for continuity of essential surgical care emerged as notable response strategies observed across all participating institutions. CONCLUSION: This study suggested that four factors are important for the resilience of surgical care against COVID-19: adequate COVID-19 testing capacity and effective institutional infection control measures, designated COVID-19 treatment facilities, whole-system approach to balancing pandemic response and meeting essential surgical needs, and active community engagement. These findings can inform healthcare institutions in other countries, especially LMICs, in their effort to tread a fine line between preserving healthcare capacity for pandemic response and protecting surgical services against pandemic disruption.

Comparison of Resilience Among Healthcare Workers During the COVID-19 Pandemics: A Multinational Cross-Sectional Survey in Southeast Asian Jurisdictions.

Objectives: To examine the level of resilience among the frontline healthcare workers (HCWs) in four different Southeast Asian jurisdictions and identify the potential factors that may enhance healthcare workers resilience. Methods: An online cross-sectional survey was carried out among 3,048 eligible healthcare workers in Hong Kong, Nepal, Vietnam, and Taiwan from May 2021 to July 2022, and information on individual resilience, socio-demographic characteristics, organizational supports, and personal exposures were collected. A binary logistic regression model was used to identify the factors that were associated with a high resilience level. Results: The resilience score was the highest among healthcare workers of Vietnam, followed by Taiwan and Hong Kong, with Nepal scoring the lowest. Participants with old age, part-time work, higher education level, more satisfaction with workplace policy, better organizational supports, and fewer COVID-specific worries were associated with higher resilience. Healthcare workers who were satisfied with the overall organizational policy support had an OR of 1.48 (95% CI: 1.25-1.76) for a high resilience level. Conclusion: Implementing satisfying organizational policies and establishing supportive work environments for frontline healthcare workers can increase individual resilience and organizational stability.

Genomic Characterization of a Relative of Mumps Virus in Lesser Dawn Bats of Southeast Asia.

The importance of genomic surveillance on emerging diseases continues to be highlighted with the ongoing SARS-CoV-2 pandemic. Here, we present an analysis of a new bat-borne mumps virus (MuV) in a captive colony of lesser dawn bats (Eonycteris spelaea). This report describes an investigation of MuV-specific data originally collected as part of a longitudinal virome study of apparently healthy, captive lesser dawn bats in Southeast Asia (BioProject ID PRJNA561193) which was the first report of a MuV-like virus, named dawn bat paramyxovirus (DbPV), in bats outside of Africa. More in-depth analysis of these original RNA sequences in the current report reveals that the new DbPV genome shares only 86% amino acid identity with the RNA-dependent RNA polymerase of its closest relative, the African bat-borne mumps virus (AbMuV). While there is no obvious immediate cause for concern, it is important to continue investigating and monitoring bat-borne MuVs to determine the risk of human infection.

Perceptions of health and coping strategies among temporary migrant workers in East and Southeast Asia: a systematic review.

BACKGROUND: The rate of international migration for the primary purpose of employment has increased exponentially in recent decades. A significant proportion of this global movement takes place across East and Southeast Asia as workers move on a temporary basis from lower-middle-income home countries such as Indonesia, the Philippines, Thailand and Vietnam to high-income host destinations including Hong Kong and Singapore. Relatively little is known about the unique and long-term health needs of this heterogeneous group of people. This systematic review presents an analysis of recent research into the experiences and perceptions of health of temporary migrant workers in the East and Southeast Asian regions. METHODS: Five electronic databases CINAHL Complete (via EbscoHost), EMBASE (including Medline), PsycINFO (via ProQuest), PubMed and Web of Science, were systematically searched for qualitative or mixed methods, peer-reviewed literature published in print or online between January 2010 and December 2020. Quality of the studies was assessed using the Critical Appraisal Checklist for Qualitative Research published by the Joanna Briggs Institute. Findings from the included articles were extracted and synthesised using qualitative thematic analysis. RESULTS: Eight articles were included in the review. Findings from this review indicate that multiple dimensions of workers' health is impacted by the processes of temporary migration. In addition, the research reviewed indicated that migrant workers used various strategies and mechanisms to attempt to address their health-related issues and to take better care of themselves. Such agentic practices could help them manage and maintain their health and wellbeing across physical, psychological and spiritual dimensions within the structural constraints of their employment. CONCLUSIONS: Limited published research has focused on the health perceptions and needs of temporary migrant workers in East and Southeast Asia. The studies included in this review focused on female migrant domestic workers in Hong Kong, Singapore, and the Philippines. These studies provide valuable insights but do not reflect the heterogeneity of migrants moving within these regions. The findings of this systematic review highlight that temporary migrant workers experience high and sustained levels of stress and are exposed to certain health risks which may compromise long-term health outcomes. These workers demonstrate knowledge and skills in managing their own health. This suggests that strength-based approaches to health promotion interventions may be effective in optimising their health over time. These findings are relevant to policy makers and non-government organisations supporting migrant workers.

Cross-regional analysis of the association between human mobility and COVID-19 infection in Southeast Asia during the transitional period of "living with COVID-19".

BACKGROUND: In response to COVID-19, Southeast Asian (SEA) countries had imposed stringent lockdowns and restrictions to mitigate the pandemic ever since 2019. Because of a gradually boosting vaccination rate along with a strong demand for economic recovery, many governments have shifted the intervention strategy from restrictions to "Living with COVID-19" where people gradually resumed their normal activities since the second half of the year 2021. Noticeably, timelines for enacting the loosened strategy varied across Southeast Asian countries, which resulted in different patterns of human mobility across space and time. This thus presents an opportunity to study the relationship between mobility and the number of infection cases across regions, which could provide support for ongoing interventions in terms of effectiveness. OBJECTIVE: This study aimed to investigate the association between human mobility and COVID-19 infections across space and time during the transition period of shifting strategies from restrictions to normal living in Southeast Asia. Our research results have significant implications for evidence-based policymaking at the present of the COVID-19 pandemic and other public health issues. METHODS: We aggregated weekly average human mobility data derived from the Facebook origin and destination Movement dataset. and weekly average new cases of COVID-19 at the district level from 01-Jun-2021 to 26-Dec-2021 (a total of 30 weeks). We mapped the spatiotemporal dynamics of human mobility and COVID-19 cases across countries in SEA. We further adopted the Geographically and Temporally Weighted Regression model to identify the spatiotemporal variations of the association between human mobility and COVID-19 infections over 30 weeks. Our model also controls for socioeconomic status, vaccination, and stringency of intervention to better identify the impact of human mobility on COVID-19 spread. RESULTS: The percentage of districts that presented a statistically significant association between human mobility and COVID-19 infections generally decreased from 96.15% in week 1 to 90.38% in week 30, indicating a gradual disconnection between human mobility and COVID-19 spread. Over the study period, the average coefficients in 7 SEA countries increased, decreased, and finally kept stable. The association between human mobility and COVID-19 spread also presents spatial heterogeneity where higher coefficients were mainly concentrated in districts of Indonesia from week 1 to week 10 (ranging from 0.336 to 0.826), while lower coefficients were mainly located in districts of Vietnam (ranging from 0.044 to 0.130). From week 10 to week 25, higher coefficients were mainly observed in Singapore, Malaysia, Brunei, north Indonesia, and several districts of the Philippines. Despite the association showing a general weakening trend over time, significant positive coefficients were observed in Singapore, Malaysia, western Indonesia, and the Philippines, with the relatively highest coefficients observed in the Philippines in week 30 (ranging from 0.101 to 0.139). CONCLUSIONS: The loosening interventions in response to COVID-19 in SEA countries during the second half of 2021 led to diverse changes in human mobility over time, which may result in the COVID-19 infection dynamics. This study investigated the association between mobility and infections at the regional level during the special transitional period. Our study has important implications for public policy interventions, especially at the later stage of a public health crisis.

COVID-19 in Southeast Asia: current status and perspectives.

Coronavirus Disease-2019 (COVID-19) has spread globally with catastrophic damages to the public health, social and economy since the beginning of the outbreak. In 2020, Southeast Asia proved that it could prevent the worst effects of a pandemic through the closure of activities and borders and movement restriction, as well as social distancing. Nevertheless, with the occurrence of the common variants of concern (VOCs), especially Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), Southeast Asia is facing a significant increase in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections. Now, the area also has the threats of the spreading out of the dangerous variant - Omicron (B.1.1.529) from other close countries or regions. COVID-19 countermeasures such as closures and social distancing seem to be insufficient. Moreover, Southeast Asia is being held back by a shortage of vaccines and other medical resources. This work focuses on describing the COVID-19 situation, the virus variants, and the coverage of COVID-19 vaccination in the area. We also provide perspectives on the COVID-19 vaccine distribution, protecting the economic capitals, developing the green zone, and the importance of finding more vaccine supplies in Southeast Asia.

Correlations between COVID-19 and dengue obtained via the study of South America, Africa and Southeast Asia during the 2020s.

A dramatic increase in the number of outbreaks of dengue has recently been reported, and climate change is likely to extend the geographical spread of the disease. In this context, this paper shows how a neural network approach can incorporate dengue and COVID-19 data as well as external factors (such as social behaviour or climate variables), to develop predictive models that could improve our knowledge and provide useful tools for health policy makers. Through the use of neural networks with different social and natural parameters, in this paper we define a Correlation Model through which we show that the number of cases of COVID-19 and dengue have very similar trends. We then illustrate the relevance of our model by extending it to a Long short-term memory model (LSTM) that incorporates both diseases, and using this to estimate dengue infections via COVID-19 data in countries that lack sufficient dengue data.

Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method.

BACKGROUND: The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA. OBJECTIVE: The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19. METHODS: We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages. RESULTS: We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between -0.05 and -1.46 due to the assistance of continuous restrictions. However, 58.6% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic. CONCLUSIONS: The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19.

First case series and literature review of coronavirus disease 2019 (COVID-19) associated pulmonary tuberculosis in Southeast Asia: Challenges and opportunities.

BACKGROUND: Subclinical tuberculosis (TB) is accidentally detected by radiologic and microbiologic findings. Transmission by those with subclinical TB could delay prevention effort. However, our study demonstrated positive aspect of COVID-19 outbreak as it could allow subclinical TB to be detected faster through a chest X-Ray (CXR). METHODS: This cross-sectional cohort study aimed to report demographics, comorbidities, and outcomes related to early detection of TB among COVID-19 patients, and to elaborate the association between SARS-CoV-2 and pulmonary TB. Data of patients with SARS-CoV-2 co-infection with Mycobacterium tuberculosis (MTB) diagnosed between March 2020 - March 2022 was collected. RESULTS: Out of 12,275 COVID-19 patients, 26 were definitively diagnosed with MTB infection (mean age 48.16 ± 20.17 years). All cases that had suspicious CXR that were not typical for COVID-19, were tested for MTB. On average, pulmonary TB was diagnosed after admission 5(3-10) days, the treatment initiation period was 3(1-5) days from the TB diagnosis. CONCLUSIONS: This suggests an early detection of tuberculosis among COVID-19 patients by quicker screening CXR and sputum comparing to previous symptom guided screening. Thereby reducing the chance of TB transmission demonstrated during COVID-19 pandemic. So, clinicians should be aware of pulmonary tuberculosis in COVID-19 patients with atypical radiologic findings.

Spatial variations in vegetation fires and emissions in South and Southeast Asia during COVID-19 and pre-pandemic.

Vegetation fires are common in South/Southeast Asian (SA/SEA) countries. However, very few studies focused on vegetation fires and the changes during the COVID as compared to pre-pandemic. This study fills an information gap and reports total fire incidences, total burnt area, type of vegetation burnt, and total particulate matter emission variations in SA/SEA during COVID-2020 and pre-pandemic (2012-2019). Results from the short-term 2020-COVID versus 2019-non-COVID year showed a decline in fire counts varying from - 2.88 to 79.43% in S/SEA. The exceptions in South Asia include Afghanistan and Sri Lanka, with a 152% and 4.9% increase, and Cambodia and Myanmar in Southeast Asia, with an 11.1% and 8.5% increase in fire counts in the 2020-COVID year. The burnt area decline for 2020 compared to 2019 varied from - 0.8% to 92% for South/Southeast Asian countries, with most burning in agricultural landscapes than forests. Several patches in S/SEA showed a decrease in fires for the 2020 pandemic year compared to long term 2012-2020 pre-pandemic record, with Z scores greater or less than two denoting statistical significance. However, on a country scale, the results were not statistically significant in both S/SEA, with Z scores ranging from - 0.24 to - 1, although most countries experienced a decrease in fire counts. The associated mean TPM emissions declined from ~ 2.31 Tg (0.73stdev) during 2012-2019 to 2.0 (0.65stdev)Tg in 2020 in South Asia and 6.83 (0.70stdev)Tg during 2012-2019 to 5.71 (0.69 stdev)Tg in 2020 for South East Asian countries. The study highlights variations in fires and emissions useful for fire management and mitigation.

COVID-19 Vaccination Willingness in Four Asian Countries: A Comparative Study including Thailand, Indonesia, the Philippines, and Vietnam.

Globally, 67% of the population has received at least one COVID-19 vaccine dose, but coverage varies across countries. This study aimed to compare people's willingness to receive COVID-19 vaccination across Thailand, Indonesia, Philippines, and Vietnam, where vaccination intention tends to be high, to determine factors associated with willingness, and to obtain suggestions for developing strategies. We conducted a secondary data analysis of the Japan International Cooperation Agency survey "Building Resilience: COVID-19 Impact and Responses in Urban Areas-Case of Southeast Asia," including1842 unvaccinated participants from Thailand (n = 461), Indonesia (n = 246), the Philippines (n = 609), and Vietnam (n = 526). Vaccination willingness was high in all countries (69.6%), but the social and psychological factors motivating people to undergo vaccination differed among these countries. The highest vaccination willingness was in the Philippines, followed by Vietnam and Indonesia, whereas the lowest vaccination willingness was in Thailand. Vaccination willingness was affected by not only sociodemographic attributes, but also risk perception and beliefs, which, in turn, were shaped by social factors such as infection trends and vaccine policies. To achieve effective vaccination promotion programs, a system allowing the flexible modification of promotion methods in response to social conditions must be established.

COVID-19 preventive behavior among university students in Southeast Asia: Effects of knowledge, concern, awareness, and perceived risk.

The persistent rise of pandemics across the globe in recent times has led to the prescription of several collaborative preventive strategies to reduce the effect that the pandemic has on public health. Consistent monitoring and surveillance appear to be the only available approach to detecting and classifying the issues of public health threats. Global pandemic threats demand public co-operation to take preventive actions at a personal level so that the risk of infectious diseases can be contained. Said that, this study explored the influence of awareness of precaution measures (APM), concerns about coronavirus disease 2019 (COVID-19) (CAC), knowledge of COVID-19 (KOC), and perceived risk (PRK) on preventive behavior (PRB), as well as the effect of age and gender on the relationships among the studied variables. Quantitative data were collected from 551 university students across Malaysia and Vietnam through field survey and online survey, respectively. The data collection was performed from 13 March to 23 March 2020. Partial least square structural equation modeling (PLS-SEM) was employed for data analysis. The multiple group analysis (MGA) technique was applied to compare the data retrieved from the respondents based on age and gender. The results revealed that APM, CAC, KOC, and PRK on PRB significantly influenced PRB toward COVID-19. In light of the two personal factors, age and gender, significant variances were noted for age and KOC, while PRK on PRB on the PRB toward COVID-19. Based on the study outcomes, APM emerged as the most significant predictor of PRB, followed by PRK on PRB, and CAC. Since a large fraction of the world reside in rural areas and have high-level interaction with animals, the provision of education at all level can harness the attitude to adopt PRB toward COVID-19. As such, policymakers need to work with the young generation so that the latter may serve as change agents to spread the message of taking precautions and adopting effective PRB toward COVID-19.

The pathogenesis of Nipah virus: A review.

Nipah virus (NiV), an emerging zoonotic virus, has been associated with several outbreaks with high death rates, mainly in South and Southeast Asia. NiV is responsible for Encephalitis and systemic vasculitis, and occasionally respiratory diseases accompanied by it. Though fruit bats are the natural source of NiV, it can be transmitted in a zoonotic manner directly or via an intermediate host (e.g., a pig or horse). Several studies explore the viral mechanism of disease progressions and its overall pathogenesis. However, understanding the pathogenesis and disease dynamics is necessary to develop therapeutic options and vaccines. Thus, in this review, we provide a comprehensive update on the emerging understanding of the pathogenesis of NiV.

A strategy to assess spillover risk of bat SARS-related coronaviruses in Southeast Asia.

Emerging diseases caused by coronaviruses of likely bat origin (e.g., SARS, MERS, SADS, COVID-19) have disrupted global health and economies for two decades. Evidence suggests that some bat SARS-related coronaviruses (SARSr-CoVs) could infect people directly, and that their spillover is more frequent than previously recognized. Each zoonotic spillover of a novel virus represents an opportunity for evolutionary adaptation and further spread; therefore, quantifying the extent of this spillover may help target prevention programs. We derive current range distributions for known bat SARSr-CoV hosts and quantify their overlap with human populations. We then use probabilistic risk assessment and data on human-bat contact, human viral seroprevalence, and antibody duration to estimate that a median of 66,280 people (95% CI: 65,351-67,131) are infected with SARSr-CoVs annually in Southeast Asia. These data on the geography and scale of spillover can be used to target surveillance and prevention programs for potential future bat-CoV emergence.