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Morbidity and Mortality Weekly Report (MMWR)
 (Weekly)

Instructions for Contributors

Contents
I. Criteria for Publication
II. Publication of the Report
III. Standards for Writing
IV. Submission Format and Structure
V. Clearance
VI. Submitting the Report
VII. Review
VIII. Production
IX. Notices to Readers
X. Errata
XI. Contact Information

I. Criteria for Publication

  1. Appropriateness. A report must contain science-based public health information. Recommendations must be from CDC, federally sanctioned advisory committees, or other public health agencies or organizations. Surveillance reports represent data from public health monitoring systems.
  2. Originality. A report must contain new or original information or guidelines/recommendations that substantially increase understanding of a public health problem.
  3. Quality. A report must be based on analyses using acceptable scientific methods that include sufficient data to adequately describe the public health topic.
  4. Timeliness. A report must contain data recently collected to investigate and describe a public health problem or must contain the most current data from a survey or other epidemiologic system or study. The priority of production and editing of a report is related, in part, to the currency of the report. Reports on investigations in progress or completed within 6 months of submission have a high priority for publication. Reports describing events or data collected more than several years before submission are at high risk for rejection.
  5. Clarity. A report must contain data that are relevant, concise, well interpreted, and linked to specific public health actions.
  6. Editorial standards. A report must be of the length, structure, and style described in these instructions. Reports that best meet the criteria for publication have the highest priority for publication.

II. Submission and Scheduling (updated September 12, 2008)

  1. Before writing or submitting a report, contributors should propose the report to the Editor (FShaw@cdc.gov) or Managing Editor (TRutledge@cdc.gov) to discuss its suitability for MMWR. Proposals should include an approximately 250-word summary of the proposed article, to include a statement of the public health problem being addressed, the methods used, the primary results, and the principal public health message(s) to be conveyed, including any recommendations that might appear in the report. If the proposed report is an update of previously published reports in MMWR, contributors should so indicate and provide a reference to the earlier publication. After reviewing the proposal, the Editor or Managing Editor will request submission of the proposed report (i.e., “green light”). Contributors will be notified promptly by e-mail. 
  2. After a report has been accepted for publication (see section VII.), MMWR will assign a scheduled publication date. Scheduled publication dates are assigned in consultation with contributors and are subject to MMWR editorial priorities (e.g., issue size) and contributor availability. MMWR expects that the majority of reports will be published on the scheduled publication date and will make every effort to do so. However, scheduled publication dates are subject to change for reasons that include but are not limited to intervening MMWR editorial priorities (e.g., publication of more urgent reports), contributor availability, editorial contingencies, or clearance issues.
  3. To assist contributors in planning, MMWR may issue tentative scheduled publication dates.  However, all such publication dates should be considered tentative and contingent on acceptance by the Editor, conformance to all CDC and MMWR clearance requirements, and the factors listed in these Instructions for Contributors. Tentative scheduled publication dates are subject to change for the reasons listed in the preceding paragraph. For reports (except expedited reports, see section IV.D.) that have been issued tentative publication dates, the final, cleared manuscript must be submitted to MMWR no later than 22 calendar days (i.e., three Wednesdays) before the issue date. Exceptions to this requirement may be granted by the Editor for extraordinary circumstances.

III. Standards for Writing (updated September 12, 2008)

  1. Contributors should carefully read and follow these standards for writing. Reports submitted to MMWR that are substantially not in accordance with these standards will be returned to the contributors for rewrite and resubmission.
  2. Text. For word processing, use MS Word. Maximum length of reports is 1,400 words at submission  (excluding title, credits, footnotes, references, tables, and figures), unless otherwise indicated. Double-space text, including references and footnotes. Indent paragraphs; leave no extra space between paragraphs. After a period, leave only one space before beginning the next sentence. Use 12-point Times New Roman font. Italicize (rather than underline) scientific names when needed.
  3. Credits (i.e., "Reported by" section). See MMWR contributor attribution policy.
  4. References. Cite <10 references, unless otherwise indicated. Follow Style of Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Place reference numbers in parentheses and italicize. Do not use the "endnotes" function of the word-processing program. Number references within text in order of appearance, then list in numeric order at end of report. Consult List of Journals Indexed in Index Medicus for accepted journal abbreviations; if a journal is not listed, spell out the journal title in full. Cite "personal communication" and "unpublished data" in parentheses in text.
  5. Acknowledgments. See MMWR contributor attribution policy.
  6. Tables and Figures. Include when tables and figures are necessary to clarify or enhance the text. Photographs that illustrate an outbreak setting, risk factor, or prevention intervention are encouraged. The total number of tables and figures may not exceed three.
    TABLES: created in Word table function or Excel. Tables must not have tabs or extra spaces within the cells. Tables should be sent in separate files and not embedded in text.
    FIGURES: created in (NOT PASTED INTO) Corel Draw, PowerPoint, or vector format files (such as .cdr, .cgm, .eps, and .wmf). No other formats will be accepted. With bar or line graphs, include data in tabular form. Use of color is accepted. Figures should be sent in separate files and not embedded in text. Figures, symbols, lettering, and numbering should be clear and large enough to remain legible when reduced. Place keys/legends within the figure.
  7. Footnotes. Use the following footnotes in order of appearance: *, †, §, ¶, **, ††, §§, ¶¶, and so on.

IV. Submission Format and Structure

  1. Full MMWR Reports (updated July 15, 2008)

    [Note: The following is intended as a rough guide. Report structure will vary according to the content and communication objectives of the authors and not all the elements listed will appear in every report. Contributors should always check published MMWR reports similar to their own submissions to ascertain the optimal format and structure.]

    Full MMWR Weekly reports are structured as follows (see also MMWR outbreak reports, below):
     
    1. Introduction paragraph: The first paragraph of a full report serves the same function as the abstract of an article in a typical medical journal. The National Library of Medicine uses this paragraph as the abstract for all reports published in the MMWR Weekly. The introductory paragraph should be approximately 180--250 words. It should contain the following components: a brief introductory statement orienting the reader to the topic and placing it in context; a brief description of the public health problem, which usually includes a statement of the reasons the analysis was done; a brief statement of the objectives and purpose of the analysis; a mention of the methods used; a mention of the most important findings (usually these are provided as specific quantitative results, if appropriate); one or two sentences stating the conclusions and the public health actions that should be taken in response to the findings (e.g., research, surveillance, or interventions).
    2. Methods: For most reports, the second section will be a concise summary of the methods used to conduct the analysis. Important components of this section might include the following: a description of the source(s) of the data used for the analysis and a statement of how the data were collected; case definitions and/or participant selection criteria; the time period of the study; types of specimens taken and tests performed (e.g., serology, culture, toxicology, etc.); and statistical methods used. Statistical methods always should be mentioned. For surveys, response rates should be specified. For case reports and case series, the criteria used to select the cases should be described. The methods section is meant to be a free-standing summary, and in general should not require readers to consult references to understand the key points. However, for certain complex methods, authors might opt to supplement the methods sections with a reference or footnote referring readers to more detailed explanation of methods.
    3. Results or findings: The results section is a concise presentation of the results of the analysis. Examples might include elements of the descriptive (time, place, person) and analytic epidemiological results; disease trends and rates; treatments; outcomes; and relevant laboratory values. To save space and make results more easily understandable, authors might elect to place certain results in tables or figures. Case reports and series should include reasonable details on exposure, presenting signs and symptoms, initial diagnosis, laboratory and radiological findings, treatment, and clinical course and outcome. Tables and figures (including photographs) should be used to depict findings that are not amenable to, or that can enhance, presentation in text.
    4. Actions taken or proposed: If appropriate, a short section describing control measures implemented and other interventions and policy implications.
    5. Reported by section: See MMWR contributor attribution policy.
    6. Editorial Note: The editorial note functions like the discussion section of a typical medical journal article. The principal purposes of the editorial note are to: state the conclusions of the report, avoiding mere repetition of results; interpret the results and convey their public health meaning (answering the “so what?” question); place the results into context by mentioning comparative or corroborative studies; state the limitations of the analysis (e.g., biases inherent in the study method, limits on generalizability, and other potential limitations---in MMWR this is done formally in a “limitations paragraph”); state the implications of the findings for use in public health practice (i.e., public health application); and present prevention and control recommendations, if appropriate. When appropriate, specific examples of successful public health interventions can help readers understand the state of public health practice in the area under discussion.
    7. New recommendations: New recommendations in the MMWR Weekly are presented in the editorial note and should be accompanied by an understandable and concise scientific rationale. Because of the short format of the Weekly, supporting information necessarily is brief. Contributors should consider including the following points: how the new recommendations add to or differ from previous recommendations; what information was considered, or not considered, and why; and how the information considered supports or relates to the new recommendations.
    8. Acknowledgments: See MMWR contributor attribution policy.
    9. Maximum length: Unless otherwise indicated, maximum length of report at submission is 1,400 words (excluding title, credits, footnotes, references, tables, and figures).
       
  2. Full MMWR Reports, Outbreaks (updated July 15, 2008)

    [Note: The following is intended as a rough guide. Outbreak report structure will vary according to the content and communication objectives of the authors and not all the elements listed will appear in every report. Contributors should always check published MMWR outbreak reports similar to their own submissions to ascertain the optimal format and structure.]

    MMWR Weekly reports concerning outbreaks of disease follow a slightly different structure than other full reports. Outbreak reports are intended to tell a story of what happened during an investigation and control of an outbreak. As much as possible, these reports should attempt to track the chronological sequence of the outbreak and the investigation. However, for many outbreak reports, it is not possible to present events and findings in a strict chronological order. Even so, contributors should strive to keep readers oriented to the temporal sequence of events.

  3.  
    1. Introductory paragraph: The first paragraph of an outbreak report in the MMWR Weekly serves the same function as the abstract of an article in a typical medical journal. The National Library of Medicine uses this paragraph as the abstract for all reports in the MMWR Weekly. The introductory paragraph should be approximately 180--250 words. Generally, the introductory paragraph begins with 1--3 sentences establishing the existence of the outbreak or underlying public health problem, or presenting the first discovery of the outbreak (e.g., “On January 2, 2008, the Nevada State Health Division [NSHD] contacted CDC concerning surveillance reports received by the Southern Nevada Health District [SNHD] regarding two persons recently diagnosed with acute hepatitis C. A third person with acute hepatitis C was reported the following day,” or “On September 18, 2006, the California Department of Public Health [CDPH] was notified of two children hospitalized with hemolytic uremic syndrome [HUS]. One of the patients had culture-confirmed Escherichia coli O157:H7 infection, and both patients had consumed raw [unpasteurized] cow milk in the week before illness onset.”) The introductory paragraph usually contains the following other components: a mention that an investigation was conducted, when and by whom; a brief introductory statement orienting the reader to the outbreak disease or condition and placing it in context; a mention of a few of the most important findings (usually these are provided as specific quantitative results); a mention of the public health actions taken to stem the outbreak; and a statement of the public health implications and the public health actions that should be taken in response to the results of the outbreak investigation.
    2. Initial investigation: The next 1--2 paragraphs present the initial investigation and its findings. This might include the following: a statement of how the outbreak came to the attention of health authorities; a clinical description of the index case or initial cases; initial key laboratory of radiological results; key results of initial freeform interviews; hypothesis generation activities and results; immediate actions taken, such as control measures implemented before a full investigation was initiated.
    3. Setting: A brief description of the setting of the outbreak usually appears next. For example, if the outbreak occurred in a hospital, a brief description of the hospital by size, type, and major characteristics relevant to the outbreak. If the outbreak occurred in a community, a brief description of the community is helpful. If the outbreak involved the manufacture or harvest of a product, a brief description of the factory, manufacturing process, or harvest method can aid understanding.
    4. Descriptive investigations and results: Next is presented a description of the investigation and the results. This usually includes the following: case definition; case finding activities; method of investigation, including statistical methods; and results. Cases are counted and described by clinical characteristics, treatment, and outcome, followed by time, place, and person descriptive results. Important descriptive results might include: basic demographic characteristics of cases (age, race/ethnicity, sex); geographic residence or location; time and/or date of exposure and onset of symptoms; clinical signs and symptoms and severity; laboratory and radiological results; health-care seeking characteristics (doctor visits, hospitalizations); vaccination status and other host factors (when relevant); clinical course, treatments, and outcomes; and other key case characteristics. These results usually are accompanied by one or more tables, an epidemic curve, or a map. Occasionally a photograph can be helpful (e.g., photograph of patient, a lesion, a radiograph, a laboratory illustration, or an implicated product).
    5. Other descriptive results: Some outbreak reports then present the results of special descriptive analyses, such as anecdotes of exposures indicative of etiology (e.g., a patient who had only one unique exposure), analyses of exposures (e.g., an analysis of the location of a foodhandler’s workstation in relation to other foodhandlers; an analysis of person-to-person contacts), or other similar information.
    6. Analytical investigations and results: Next, the methods (including statistical methods) and results of any analytical epidemiological studies are presented (e.g., cohort or case-control studies).
    7. Environmental investigations and results: Environmental investigations then follow. These might include inspections of facilities or environments, environmental testing and results, microbiological and genetic epidemiological results, toxicological results, etc.
    8. Control measures taken: Some outbreak reports include a short paragraph summarizing any public health interventions taken and the results of the interventions follows.
    9. Editorial note: The editorial note in an outbreak report functions like the discussion section in a typical medical journal article. The principal purposes of the editorial note are to state the conclusions of the investigation, avoiding mere repetition of results; interpret the results and convey their public health meaning and importance (answering the “so what?” question); place the results into context by mentioning comparative or corroborative outbreak investigations and other studies; state the implications of the findings for use in public health practice (i.e., public health application); and present prevention and control recommendations, if appropriate. Outbreak reports do not always include a formal limitations paragraph. Instead, limitations of the investigation and analysis often are woven into various parts of the discussion in the editorial note.
    10. New recommendations: New recommendations based on the outbreak investigation are presented in the editorial note and should be accompanied by concise and understandable scientific rationale. Because of the short format of Weekly reports, supporting information necessarily is brief. Contributors should consider including the following points: how the recommendations add to or differ from previous recommendations; what information was considered, or not considered, and why; and how the information considered supports or relates to the recommendations.
    11. Acknowledgments: See MMWR contributor attribution policy.
    12. Maximum length: Unless otherwise indicated, maximum length of outbreak reports at submission is 1,400 words (excluding title, credits, footnotes, references, tables, and figures).
       
  4. Brief Reports

    Brief Reports describe ongoing or recently completed (within the previous 90 days) investigations or evaluations conducted by CDC, state and local health departments, and other public health or safety agencies. Brief Reports do not contain an Editorial Note. A brief report is structured as follows:

    1. Nature of problem, including public health implications, if applicable.
    2. Clinical and/or laboratory features.
    3. Epidemiologic and laboratory investigations.
    4. Outcome and/or resolution.
    5. Public health action.
    6. Current status of investigation.
    7. Credits and acknowledgments: See MMWR contributor attribution policy.
    8. Cite no more than three references.
    9. No more than one figure or table.
    10. Maximum length is 750 words.
       
  5. Expedited Reports (updated June 12, 2008)

    MMWR has the capability to publish reports rapidly (i.e., within hours) in electronic form. Expedited MMWR reports are categorized as either Dispatches or Early Releases. Dispatches and Early Releases can be published in any of the MMWR Weekly formats (i.e., a Full Report, a Brief Report, a Notice to Readers, or an Erratum). In general, an MMWR Dispatch is issued when, in the judgment of the MMWR Editor after consultation with the contributors, a need exists to advise MMWR readers rapidly (i.e., within hours) of a substantial and acute public health problem that is requiring urgent action. An Early Release is issued when, in the judgment of the Editor after consultation with the contributors, some other compelling reason exists to publish a report ahead of the regular weekly schedule.

    MMWR Dispatches are published electronically on a 24-hour, 7-day basis as soon after submission as possible. To accommodate MMWR production schedules, except under extraordinary circumstances, Early Releases are not published after 6 PM or on Fridays, weekend days, or holidays. Contributors who wish to submit reports as a Dispatch or Early Release should contact MMWR for complete information on applicable procedures.

    All expedited reports are subject to these Instructions for Contributors, and all must be accepted for publication by the Editor. MMWR reserves the prerogative to give priority to the publication of expedited reports, and these reports can displace other pending reports. Contributors who wish to publish an expedited report in MMWR should, as early in the writing process as possible, contact the Editor or the Managing Editor, MMWR.
     

  6. Achievements in Public Health

    These special reports highlight sustained and measurable advances in public health that contributed to reducing major causes of morbidity and mortality. MMWR publishes no more than two per year. Maximum length is 2,200 words, excluding title, credits, references, figures, and tables. These reports do not require an Editorial Note. Cite <25 references.

V. Clearance (updated June 12, 2008)

MMWR publishes only reports that have been cleared according to CDC and MMWR clearance policies. Before being submitted to MMWR for publication, reports must receive clearance from the following:

  1. All entities that are required to clear the report in accordance with the current CDC Clearance Policy;
  2. Local and state health departments involved in the investigation or analysis (for states, usually the state epidemiologist);
  3. CDC branches, divisions, and national centers (or CDC Offices) that have programmatic responsibility over the report’s topic;
  4. CDC branches, divisions, and national centers (or CDC Offices) in which any named contributor of the report is employed;
  5. Other federal agencies that are mentioned in the report or have substantial programmatic or regulatory jurisdiction over matters mentioned in the report;
  6. Private-sector organizations, international health agencies, ministries of health, and other organizations at which any named contributor is employed, according to the clearance policies for the organization, agency, or ministry; and
  7. If requested by MMWR, other organizational units at CDC or other federal agencies with subject matter, programmatic, or regulatory jurisdiction or interest in the report.

VI. Submitting the Report

  1. Submit the report to mmwreditors@cdc.gov. Send all text, tables, and figures as separate attachments.
  2. Provide name, address, telephone and fax numbers, and e-mail addresses of primary contributor or contact and a back-up contact. 
  3. Fax clearance information to the Managing Editor at 404-498-2389.

VII. Review (updated June 12, 2008)

  1. MMWR staff will confirm receipt of the report by telephone or e-mail.
  2. All reports must be accepted for publication by the Editor. Decisions to accept or decline reports are based on the criteria in these Instructions, section I, A-F. Reports might be accepted contingent on editorial changes recommended by the Editor or recommendations from other reviewers, additional clearances or reviews, or other requirements. Other reports might be placed on hold, pending rewrite or answers to queries from the Editor. The MMWR Editor or designee may solicit reviews of submitted reports by CDC programs, external experts, or other federal agencies.
  3. Before publication, all MMWR reports are submitted to CDC's Office of the Chief Science Officer (OCSO) for comment and clearance. In addition, in the week before publication, all MMWR reports are reviewed routinely by CDC's Office of the General Counsel, CDC national centers, other CDC offices, other federal agencies (e.g., the U.S. Food and Drug Administration), and other entities as needed. Comments received from OCSO and other reviewers are reviewed by MMWR and then forwarded to contributors.

VIII. Production (updated June 12, 2008)

  1. MMWR seeks to publish submitted reports as soon as possible after acceptance. However, the time between acceptance and publication can vary for reasons that include, but are not limited to, the volume of reports awaiting publication, intervening MMWR editorial priorities (e.g., publication of more urgent reports), contributor availability, editorial contingencies, or clearance issues.
  2. Contributors should be aware of all production cycle deadlines that might affect their submission. At least one originating contributor must participate in the production cycle and be immediately available by e-mail and telephone during this time. Interruptions in contributor availability could result in postponement of publication.
  3. At least one contributor must be available the day before and the date of publication to respond to news media inquiries. CDC staff should contact the Associate Director for Communications at their national center for additional information. Contributors from other organizations should contact their media relations department.

IX. Notices to Readers

  1. Scientific notices to readers
     
    1. Scientific notices to readers describe changes in recommended public health practices (e.g., vaccine recommendations) that CDC co-sponsors or supports. Maximum length is <1,400 words.
       
  2. Announcements
     
    1. Announcements describe upcoming training courses, conferences, publications, and public health events (e.g., World AIDS Day). Maximum length is <150 words.
    2. Announcements are published when space is available; however, some are scheduled for publication in conjunction with a special event.

X. Errata

Errata are published as soon as possible after the need for such has been brought to the attention of MMWR staff.

XI. Contact Information

  1. Address: Editor (or Managing Editor) MMWR Office, Mailstop E-90, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333.
  2. Editor, Frederic E. Shaw, MD, JD; e-mail FShaw@cdc.gov;
    telephone: 404-498-6364; fax: 404-498-2389.
  3. Managing Editor, Teresa Rutledge; e-mail TRutledge@cdc.gov;
    telephone: 404-498-2371; fax: 404-498-2389.
  4. Electronic MMWR: mmwrq@cdc.gov (MMWR Questions mailbox); mmwreditors@cdc.gov (MMWR Editors inbox).

 

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Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A
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