New students at a boarding martial arts school in Dengfeng City, China, carried Neisseria meningitidis, the bacterium that can cause meningococcal disease, at strikingly high rates during their first year at the institution, according to a prospective cohort study conducted by researchers from the Henan Provincial Center for Disease Control and Prevention and partner institutions. Over thirteen rounds of follow-up sampling between February and December 2025, carriage prevalence ranged from 30.00 percent to 93.75 percent and showed an overall upward trend as the cohort lived and trained together.
The study, published in Frontiers in Public Health, followed 60 new entrants at the school, collecting oropharyngeal swabs at regular intervals and testing them in the laboratory. Rather than relying on single snapshots of carriage, the team applied a hidden Markov model to estimate how often students acquired the bacterium and how long they carried it, and used proportional hazards models to identify factors that influenced acquisition and clearance.
The results revealed how unstable carriage can be at the individual level even as prevalence climbed across the cohort. Among the 59 students who tested positive at some point during the observation period, 52.54 percent—31 of 59—experienced two or more distinct carriage episodes, meaning they cleared the bacterium and acquired it again. Moreover, 35.59 percent—21 of 59—carried two or more different serogroups over time, indicating frequent switching between meningococcal strains. Serogroups B and X were the predominant types identified during the study.
The hidden Markov model estimated a mean carriage duration of 7.38 months, with a 95 percent confidence interval of 4.18 to 13.01 months. That point estimate implies that, on average, a student who acquired the bacterium carried it for well over half a year, a duration the authors describe as prolonged.
The analysis of risk factors produced a nuanced picture. For acquisition, students aged 15 years or older had a higher rate of picking up N. meningitidis than younger students, with a hazard ratio of 2.01 and a 95 percent confidence interval of 0.99 to 4.08—an estimate that was borderline, with its confidence interval just including the null value of 1. Students with a history of smoking showed a higher acquisition rate than non-smokers, with a hazard ratio of 1.48 (95 percent CI: 0.76 to 2.91), but the authors note this difference was not statistically significant.
Clearance patterns told a different story. Two factors were significantly associated with faster elimination of the bacterium: being aged 15 years or older, with a hazard ratio of 4.40 (95 percent CI: 1.49 to 13.00), and having had fever in the past week, with a hazard ratio of 4.16 (95 percent CI: 1.36 to 12.75). In other words, older students and those who had recently experienced fever cleared carriage substantially more quickly than their counterparts.
Two other factors pointed in the same direction for clearance without reaching statistical significance. Smoking history was associated with a higher clearance rate, with a hazard ratio of 3.39 (95 percent CI: 0.92 to 12.53), and antibiotic use showed a hazard ratio of 2.58 (95 percent CI: 0.74 to 9.05). The authors interpret these as potential associations that warrant further investigation rather than established effects, and the wide confidence intervals reflect the limited number of events in a cohort of this size.
The study has clear limitations inherent to its design. It followed a single cohort of 60 students at one boarding martial arts school in one Chinese city, so the findings may not generalize to other congregate settings or populations. The confidence intervals around several of the hazard ratios are wide, and some cross the null, meaning the direction of certain effects remains uncertain. The authors also emphasize that the results are observational; the identified associations describe patterns in this cohort rather than proven causal relationships.
The combination of high and rising carriage prevalence, a long average carriage duration, frequent repeat episodes, and frequent serogroup switching paints a picture of intense bacterial circulation among new entrants as they mixed for the first time. The authors conclude that these findings underscore the need for strengthened health surveillance and behavioral interventions in such congregate settings to reduce the risk of persistent carriage and onward transmission, and they position the work as empirical evidence for developing targeted prevention strategies against meningococcal disease in boarding schools.
Subject of Research: Longitudinal dynamics of Neisseria meningitidis carriage among new students at a boarding martial arts school in China
Article Title: Dynamic characteristics of Neisseria meningitidis carriage among new students in boarding martial arts schools: a longitudinal follow-up study
Article References: Li, J., Liu, Y., Kong, J., Wang, X., Tian, T., Zhang, X., Zhang, X., Ji, Y., Guo, Y., Liu, Q., Chen, S., & Zhang, Y. (2026). Dynamic characteristics of Neisseria meningitidis carriage among new students in boarding martial arts schools: a longitudinal follow-up study. Frontiers in Public Health, 14, Article 1941998. https://doi.org/10.3389/fpubh.2026.1941998
Image Credits: AI Generated
DOI: 10.3389/fpubh.2026.1941998
Keywords: Neisseria meningitidis, meningococcal carriage, boarding school, hidden Markov model, oropharyngeal swabs, serogroup B, serogroup X, carriage duration, cohort study, public health surveillance, Henan, congregate settings
News Source: Phoebe Ingram. (October 28, 2026). Meningococcal Carriage Rises Sharply Among New Boarding Martial Arts Students. Scienmag.
