Morbidity and Mortality Weekly Report (MMWR) Weekly

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Instructions for Authors
(Updated April 11, 2024)

Contents

1.0 Criteria for Publication

2.0 Types of Reports

3.0 Authorship and Acknowledgment

4.0 Specific Guidance on Formatting Submissions

5.0 Clearance, Submission, and Acceptance

6.0 Scheduling and Editing

7.0 Submitting Supplementary Tables and Figures

8.0 Prepublication Sharing of MMWR Reports

9.0 Guidance for Correcting Errors Post-Publication

10.0 Contact Information

1.0 Criteria for Publication

Appropriateness: MMWR Weekly publishes information useful to readers in the public health community, clinicians, researchers, teachers and students, and the news media. Reports are based on science (especially epidemiology) or on public health policy or practice. Recommendations contained within reports must be consistent with CDC policy.

Originality: Reports should not have been previously published elsewhere or contain primary results that have previously been released with the exception of presentation at scientific meetings.

Quality: Reports should be based on analyses using accepted scientific methods and should include sufficient data to adequately address the public health topic.

Timeliness: Reports should contain the most current data from surveys, surveillance systems, or studies, and the most recent data should not be older than 2 years at the time of submission. Data from outbreaks and other public health investigations should not be older than 10 months at time of submission.

Clarity: Reports should be succinct and organized logically with the reader in mind, with minimal use of acronyms and initialisms.

2.0 Types of Reports

Five types of reports are published in MMWR Weekly: 1) Full Reports, 2) Outbreak Reports, 3) Policy Notes, 4) Notes from the Field, and 5) Vital Signs.

https://wcms-wp.cdc.gov/mmwr/wp-admin/post.php?post=5280&action=edit#/

Report Types Report Elements
Full Reports describe a completed investigation or study that answers a question of public health importance. Ideally, the answer should be one that can guide future public health practice. Unstructured abstract (150–200 words)
≤1,400 words
≤3 tables, figures, or boxes
≤10 references
≤16 footnotes
Summary box
<3 supplementary tables or figures (optional)
Outbreak Reports describe the methods, findings, and public health actions of an in progress or recently completed outbreak or other public health investigation. As much as possible, an Outbreak Report should tell the story and read like a chronologic narrative. Unstructured abstract (150–200 words)
≤1,400 words
≤3 tables, figures, or boxes
≤10 references
≤16 footnotes
Summary box
<3 supplementary tables or figures (optional)
Policy Notes are intended to announce new official CDC policies or recommendations. These reports can be thought of as briefer, more immediate versions of the MMWR Recommendations and Reports. Unstructured abstract (150–200 words)
≤1,400 words
≤3 tables, figures, or boxes
the minimum references necessary to support the recommendation
≤16 footnotes
Summary box
<3 supplementary tables or figures (optional)
Notes from the Field are brief reports of ongoing or recent events of concern to the public health community. These reports may contain early unconfirmed information, preliminary results, hypotheses regarding risk factors and exposures, and other similarly incomplete information. No definitive conclusions need be presented. ≤500 words
<1 table, figure, or box
≤5 references
≤5 footnotes
Summary box
Vital Signs reports are a special feature of MMWR that cover an important health threat and what actions can be taken to reduce or eliminate the health threat. The topics of MMWR Vital Signs reports align with CDC or ATSDR priorities and are invited by agency senior leadership. Vital Signs are released with a comprehensive health communications campaign. Structured abstract (≤250 words)
≤1,800 words
≤4 tables, figures, or boxes
≤20 references
≤16 footnotes
Summary box
<3 supplementary tables or figures (optional)

2.1 Full Reports

A Full Report is a report of a completed investigation or study that answers a question of public health importance. Ideally, the answer should be one that can guide future public health practice. A hallmark of MMWR Full Reports is simplicity. Each Full Report should be understandable by an informed medical or public health professional without special knowledge of the subject. These reports are intended to summarize the analysis and recommendations, not to provide every detail. A strict 10-reference rule is intended to limit the scope of the report. A good test for simplicity is whether, in a sentence or two, you can easily describe to another person what the report is about and what should be done.

Full Reports are ≤1,400 words total, not including the abstract. Full Reports typically have a labeled Abstract and labeled Introduction, Methods, Results, and Discussion sections. The Discussion contains conclusions followed by subsections labeled Limitations and Public Health Implications. Different formats and additional section headings can be used to organize more complicated reports.

2.1.1 Abstract (150–200 words, no references or footnotes)

The Abstract is similar to both a newspaper lead paragraph (i.e., who, what, when, where, why, and how?) and the abstract of a report in a typical medical journal. It will be deposited as an abstract into online databases (e.g., PubMed, PubMed Central, and Web of Science).

Include the following components (unstructured [i.e., unlabeled]):

  • Background (what is the problem? why is this worth writing about?)
  • Methods (brief summary of study design, data source, and statistical analysis)
  • Key findings (present one or two main results that support the public health message)
  • Public health message (state the implications of the findings for public health practice and any call to action or recommendations for prevention and control; for some reports, authors may choose to reference existing consensus recommendations)

All information in the Abstract should be included in the corresponding section of the body of the report.

2.1.2 Introduction

Provide background information on the problem, its public health importance, and the rationale for the work described in the report.

2.1.3 Methods

Provide a concise summary of the methods used to conduct the study and analyze the data.

  • The components of this section will vary depending on the study. Components should be identified with subheadings and might include sections, such as Study Design, Study Period, Study Population, Population Characteristics, Data Sources, Case Definitions, Inclusion and Exclusion Criteria, Data Collection, Specimen Collection, Laboratory Testing, and Statistical Methods (including modeling techniques, control variables, and α levels for significance tests). Specify response rate where relevant (e.g., for survey data).
  • Because methods involved in data collection for ongoing surveillance systems and some other databases might have been previously published, limited text should be devoted to information available elsewhere, with reference to the previous publication.

List the statistical software used for analysis, with the version and manufacturer in parentheses after the software name, as shown in the following examples:

  • “SAS software (version 9.4; SAS Institute) was used to conduct all analyses.”
  • “The best-fitting model was identified using sequential permutation tests in JoinPoint (version 4.7.0.0; National Cancer Institute).”

Specific procedures used for complex modeling (e.g., SAS PROC GENMOD) may be named but are not required.

Do not name software used for data management.

Include human subjects determination and consent statement as appropriate. CDC authors should follow the phrasing guidance at Standard Language for Human Subject Determination and Consent (cdc.gov).

2.1.4 Results

Include new findings made evident by original analyses conducted by the authors.

Concisely highlight the major results of the analysis. Content should be organized using appropriate subheadings.

  • Epidemiologic studies might describe elements of the descriptive (i.e., time, place, and person) and analytic results, disease trends, exposures, treatments, and outcomes. Appropriate subheadings might include Population Characteristics, Case Characteristics, Laboratory Results, Genetic Testing Results, Univariate Analysis, and Multivariable Analysis.
  • Case reports and series should include details on exposure, signs and symptoms, initial diagnosis, laboratory and radiologic findings, treatment, clinical course, and outcome. In reports in which more than one case is described, individual cases should be identified with subheadings (e.g., Case 1, Case 2, and others as appropriate).

Data highlighted in the text are also generally presented in a table or figure.

Data referenced in the Discussion section must be included in the Results section.

2.1.5 Discussion

Begin by stating the conclusions of the report, interpreting the results, conveying their public health meaning, and placing the results into context by citing comparative or corroborative studies.

2.1.5.1 Limitations

Include a labeled Limitations paragraph as the next to last paragraph. Limitations are aspects of the data or analysis that might affect the accuracy or validity of results.

  • Begin with “The findings in this report are subject to at least X limitations,” with “X” representing the number of limitations in the paragraph.
  • List limitations in paragraph format as “First,” “Second,” “Third,” etc., ending with “Finally” for the last limitation.
  • Indicate how each limitation might have affected the results.
2.1.5.2 Implications for Public Health Practice

Conclude with labeled Implications for Public Health Practice and any recommendations for prevention and control, including a specific call to action when possible.

  • Primary recommendations should be based on the analysis presented in the report.
  • If analyses suggest the possible benefit of public health actions that are not reflected in existing CDC guidance, language that is not policy directive should be used (e.g., “These analyses suggest that doing “X” might help prevent “Y”.).
  • Broader public health guidance that is current and related to the report topic (including existing CDC guidance and other consensus recommendations) may also be cited in this section. The source of the guidance should be described in the report and a reference to the published guidance should be included.
  • When appropriate, specific examples of successful public health interventions should be included.
  • A statement that more research is needed is not an implication for public health practice. If the report points to specific knowledge gaps that should be addressed to better inform public health practice, these gaps should be described earlier in the Discussion section.
  • Additional CDC clearance:
    • If the report contains scientific findings or conclusions that directly contradict previous CDC or CDC partners’ science that served as the basis for public health policy or recommendations, Office of Science Quality review should be requested as part of CDC Clearance, prior to submission to MMWR.

2.1.6 Other Full Report Components

Other Full Report components that are not included in the word count are listed below with links to formatting guidance.

2.2 Outbreak Reports

Outbreak Reports are ≤1,400 words total, not including the abstract. Outbreak Reports should generally follow the format of Full Reports, with some elements specific to outbreak reporting which are described below. Outbreak Reports generally include labeled Abstract, Investigation and Results, Public Health Response, and Discussion sections. Different formats and section headings can be used depending on the scope of the outbreak, its investigation, and the public health response. For example, separate sections for Epidemiologic Investigation, Environmental Health Investigation, and Laboratory Investigation, might be used to describe different components of the investigation. As much as possible, an Outbreak Report should read like a chronologic narrative and tell the story.

2.2.1 Abstract (150–200 words, no references or footnotes)

The Abstract will be deposited as an abstract into online databases (e.g., PubMed, PubMed Central, and Web of Science).

Include the following components (unstructured [i.e., unlabeled]):

  • One to three sentences establishing the existence of the outbreak or underlying public health problem
  • Statement that an investigation was conducted, when, and by whom
  • Most important findings
  • Actions taken to stem the outbreak
  • Statement of the public health implications and actions that should be taken in response to the investigation. For some reports, authors may choose to reference existing consensus recommendations.

2.2.2 Investigation and Results

Present the initial investigation and its findings. This might include the following:

  • A description of the setting and 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 test results
  • Hypothesis generation activities and results

Summarize the full investigation, including the case definition, case-finding activities, method of investigation, and results. Cases should be counted and described by clinical characteristics, treatment, and outcome, as well as by time, place, and person, if applicable.

Present the methods and results of any analytic studies (e.g., cohort or case-control studies).

Provide the results of any relevant microbiologic, genetic, or toxicologic results, and results of any testing of environmental samples.

2.2.3 Public Health Response

When appropriate, include a brief description summarizing any public health interventions taken and the results of the interventions.

2.2.4 Discussion

Format is the same as for a Full Report, except that a Limitations paragraph might not be necessary for an Outbreak Report.

2.2.5 Other Outbreak Report Components

Other Outbreak Report components that are not included in the word count are listed below with links to formatting guidance.

2.3 Policy Notes

MMWR Policy Notes are intended to communicate official CDC policies or recommendations. These reports can be thought of as briefer (≤1,400 words total, not including Abstract), more immediate versions of the MMWR series Recommendations and Reports.

Public health guidance included in an MMWR Policy Note should be developed in accordance with CDC’s Public Health Guidance Development Framework.

Prior to developing a report, programs must submit a brief (~300 word) proposal outlining the purpose of the report, methods, findings, and conclusions.

The format of Policy Notes can vary considerably, so authors should check published MMWR reports similar to their submission to help determine the optimal format and structure for their report by searching for relevant title words such as “treatment considerations,” “guidance,” or “recommendation.”

  • Headings are used for the Abstract, Introduction, Methods, Rationale and Evidence, Recommendation (or Interim Guidance or other appropriate heading), and Discussion sections.
  • Content within the sections should be organized using appropriate subheadings.

Reports should be cleared by CDC Office of Scientific Evidence and Recommendations (OSER) as part of CDC clearance, before the final cleared report is submitted through MMWR ScholarOne Manuscripts.

The following is a general guide for formatting:

2.3.1 Abstract (150–200 words, no references or footnotes)

The Abstract will be deposited as an abstract into online databases (e.g., PubMed, PubMed Central, and Web of Science).

Include the following components (unstructured):

  • Background (what is the problem? why is this worth writing about?)
  • Methods (brief summary of policy or recommendation)
  • Key findings (present one or two main results that support the public health message)
  • Public health message (state the implications of the findings for public health practice and any call to action or recommendations for prevention and control; for some reports, authors may choose to reference existing consensus recommendations)

2.3.2 Introduction

Include a paragraph that summarizes background information relevant to the policy or recommendation that can help the reader understand the context and need for the policy or recommendation.

2.3.3 Methods

Include a summary of the methods used to establish the policy or recommendation, including answers to some or all of the following questions:

  • Who was involved in the production of the guidelines or recommendations, and how?
  • What evidence base was considered?
  • What was the rationale for considering this evidence base? Was other evidence excluded from consideration and, if so, why?

2.3.4 Rationale and Evidence

Provide a concise review of the rationale for the policy or recommendation and a descriptive review of the scientific evidence used to establish it. It should include an explanation of how the policy or recommendation adds to, or differs from, relevant policies or recommendations established previously.

2.3.5 Presentation of the policy or Recommendation

State clearly when the policy or recommendation takes effect and to whom and under what circumstances it applies.

2.3.6 Discussion

Comment on the likely impact of the new policy or recommendation and plans for assessment of the policy or recommendation.

Policy Notes do not contain a limitations paragraph.

2.3.7 Other Policy Notes Components

Other Policy Notes components that are not included in the word count are listed below with links to formatting guidance.

2.4 Notes from the Field

Notes from the Field are ≤500 words total and do not have an abstract. MMWR Notes from the Field are abbreviated reports describing ongoing or recent events of concern to the public health community. Events of concern include epidemics, outbreaks, unusual disease clusters, poisonings, exposures to disease or disease agents (including environmental and toxic), and notable public health–related case reports.

Notes from the Field should include a brief unlabeled introduction, followed by two general headings: Investigation and Outcomes, and Preliminary Conclusions and Actions. Different headings can be used depending on the scope and format of the report. The following is a general guide for formatting.

2.4.1 Brief Introduction

The brief, unlabeled introduction should describe the onset of the event and when and how it came to light.

2.4.2 Investigation and Outcomes

  • Description of the investigation, magnitude, and extent of the event (e.g., number of known cases or geographical occurrence), and outcomes (e.g., hospitalizations or deaths).
  • One table, figure, or box will be considered, especially if its inclusion shortens the text.
  • Include a concise summary of the methods used to conduct the investigation and analyze the data.
  • Include human subjects determination and consent statement as appropriate. CDC authors should follow the phrasing guidance at Standard Language for Human Subject Determination and Consent (cdc.gov).

2.4.3 Preliminary Conclusions and Actions

Preliminary conclusions and actions that were, are being, or should be taken based on the findings in the report. No definitive conclusions need be presented. A limitations paragraph is not needed.

2.4.4 Other Notes from the Field Components

Other Notes from the Field components that are not included in the word count are listed below with links to formatting guidance.

2.5 Vital Signs

MMWR Vital Signs reports are a special feature of MMWR that cover an important health threat and the actions that can be taken to reduce or eliminate the health threat. The topics of MMWR Vital Signs reports align with CDC or ATSDR priorities and are invited by agency senior leadership. Vital Signs reports are released with a comprehensive health communications campaign.

Vital Signs reports have an established format, schedule of topics, and dates of publication. The format of Vital Signs includes a structured, labeled abstract (≤250 words) which will be deposited into online databases (e.g., PubMed, PubMed Central, and Web of Science) and main text (≤1800 words, not including the abstract) that contains headings for the Introduction, Methods, Results, and Discussion sections. Authors should check the most recently published Vital Signs and adhere to the format of those reports while also adhering to the general principles of Full Reports. For examples, see https://www.cdc.gov/VitalSigns/index.html.

2.5.1 Structured abstract with four subheadings below (≤250 words, no references or footnotes)

  • Introduction: background and purpose
  • Methods: database, years, respondents, weighting
  • Results: only new findings
  • Conclusions and Implications for Public Health Practice: include a call to action describing what can be done to address the problem

2.5.2 Main text (≤1,800 words)

  • Introduction: provide background information on the problem, its public health importance, and the rationale for the work described in the report.
  • Methods (content is the same as for a Full Report)
  • Results (content is the same as for a Full Report)
  • Discussion (content is the same as for a Full Report)
    • The Discussion contains conclusions followed by labeled Limitations and Public Health Implications subsections.
    • A Vital Signs discussion conclusion must include a call to action describing what can be done by various audiences to address the problem described in the report.

2.5.3 Other Vital Signs Components

Other components that are not included in the word count are listed below with links to formatting guidance.

3.0 Authorship and Acknowledgment

3.1 Authors

MMWR reports may be authored by CDC staff members, non-CDC staff members, or a combination, but not authored by artificial intelligence (AI)–assisted technologies.

MMWR attribution policy follows guidance from the International Committee of Medical Journal Editors (ICMJE).

Persons listed as authors must meet all four of the following conditions:

  1. Substantial contributions to the conception and design of the work; or the acquisition, analysis, or interpretation of data for the work
  2. Drafting the work or revising it critically for important intellectual content
  3. Final approval of the version to be published
  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

ICMJE recommends that all persons who meet the first criterion should have the opportunity to participate in the review, drafting, and final approval of the manuscript. Persons should not be listed as authors solely by virtue of their position in an organization or by attendance at a meeting. Similarly, participation only in the acquisition of funding, fieldwork, or general supervision of one or more of the authors is not sufficient for authorship. Persons or groups who reviewed a manuscript for a clearance process or who suggested revisions or limited changes to a manuscript should not be listed as authors.

In accordance with ICMJE recommendations, chatbots (e.g., ChatGPT) should not be listed as authors because they cannot be responsible for the accuracy, integrity, and originality, which are requirements for authorship. Therefore, humans are responsible for any submitted material that includes the use of AI-assisted technologies. Authors should not list AI and AI-assisted technologies as an author or co-author, nor cite AI as an author.

The order of authors should be a joint decision of the coauthors. MMWR recognizes that scientific work is a collaboration and collaborators have a responsibility to define, accept, and fulfill their roles. MMWR recommends that author order be discussed early and revised as needed as the work progresses. Author order, including choice of first author, should be based on the level of contribution to the report and the work underlying it. At times, two authors contribute equally to a report in a major role. Authors can indicate dual first or senior authorship. These authors’ names should be footnoted in the author list, and the footnotes describing equal contribution should be the first (and if also dual senior authors, second) footnotes in the report (i.e., included with all the other footnotes).

If authors request removal or addition of an author after manuscript submission or publication, they should provide MMWR with an explanation and signed statement of agreement for the requested change from all listed authors and from the author to be removed or added.

At times, a group will meet CDC’s criteria for authorship. If there is a group author on the byline, the group title and list of individual members may be included following the text of the report and any general acknowledgements; persons listed in the group will be indexed in PubMed as collaborators. MMWR follows U.S. National Library of Medicine guidance for designating authors and other contributors in MEDLINE.

All authors who are listed on the byline are responsible for disclosing all relationships and activities that might bias or be seen to bias their work as potential conflicts of interest, such as financial relationships, personal relationships, competition or rivalries, and intellectual beliefs upon article submission. If the submission is accepted for publication, the MMWR editor will draft a conflict of interest statement for the article based on the forms submitted by the authors. In general, MMWR follows guidance from the Committee on Publication Ethics (COPE), Guidelines on Good Publication Practice, and ICMJE’s Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Any individual author can be designated as the corresponding author. In accordance with ICMJE recommendations, the corresponding author has primary responsibility for communicating with MMWR staff and will

  • Ensure that all administrative requirements are met, including
  • Obtaining and archiving written permission from all persons listed as authors and all persons listed in the Acknowledgments
  • Ensuring that all ethical considerations (e.g., institutional review board review or disclosure of conflicts of interest) have been addressed
  • Be available throughout the submission, review, and publication processes to respond to editorial queries in a timely way
  • Be available after publication to respond should postpublication questions about the paper arise

3.2 Acknowledgments

An Acknowledgments section can be used to recognize the work of persons or groups who made substantial contributions to the project but who do not meet authorship criteria. MMWR style is to list persons or groups and their affiliation only. MMWR does not describe specific contributions such as “for preparing the figures” or “for editorial/statistical review,” etc.

4.0 Specific Guidance on Formatting Submissions

4.1 Report Text

Open a new Microsoft (MS) Word document to create your report. Do not use a previous journal-formatted proof as a template for your report; formatted proofs contain underlying (often unremovable) coding that interferes with MMWR processing. Typing or copying/pasting all or portions of your report into a previous proof will make your report unusable.

Text should be double-spaced and left justified (ragged right margin), and pages should be numbered.

Report components in the primary MS Word file should be in this order (not all components are required for every report):

Maximum length of reports varies by report type; refer to the appropriate section of the instructions. Word count does not include title, author information, footnotes, references, acknowledgments, or summary box.

Because MMWR represents the voice of CDC, use of first person (e.g., I, we, our) is not permitted in MMWR publications.

4.2 Report Title

Title includes topic followed by em dash (—) offset by spaces, data source (if used), location, and timeframe (date range should include an en dash (–) between beginning and ending dates with no space preceding or following the en dash. For example: “Evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program — Cherokee Nation, Oklahoma, 2015–2020.”

Do not refer to direction or comparison (e.g., “Trends in …” or “Larger…”).

4.3 Authors, Affiliations, and Corresponding Author

List of authors follows the title. Use first and last names and middle initials (optional), followed by the author’s degree or degrees (at authors’ discretion, degrees can be omitted).

Only report degrees equivalent to master’s and above (i.e., do not include bachelor’s level or below or professional certifications), and only the highest-level degrees should be used (e.g., if author has both a master’s and a PhD, report only the latter). Multiple degrees of equal rank can be listed (e.g., MD, PhD, and DVM; MS and MPH, etc.). At authors’ discretion, degrees can be omitted.

Use a superscripted numeral after each author’s degree or degrees for author affiliations provided at the end of the report. Do not combine multiple affiliations for an author under one number; each affiliation should be reported separately.

Non-CDC affiliations should include city and state.

CDC contractors should use their contract company affiliation.

Provide the corresponding author’s contact information (name [as appears in author list] and e-mail address) below the author affiliations section. The [email protected] format is preferred over the [email protected] format for the email address.

If there is a group author on the byline, the group title and list of members may be included immediately after the text of the report and any general acknowledgements. Provide author names (no degrees) and short affiliations (organization or location). Reference this report for an example.

See examples below for preferred order and format:

  • Report Title
  • List of authors:

Sharon Saydah, PhD1; Robert B. Gerzoff, MS1; Christopher A. Taylor, PhD2; Joshua R. Ehrlich, MD3; Jinan Saaddine, MD, PhD1

1Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.

4.4 Acknowledgments

List non-author contributors as “Person 1, Person 2, Affiliation 1; Person 3, Affiliation 2”; etc.

  • Do not include degrees.
  • Group together persons who are affiliated with the same CDC division or external entity and separate their names using commas; names are listed alphabetically unless the authors prefer otherwise.
  • Separate affiliations or group acknowledgments using semicolons.
  • Affiliations do not include city and state.

An example is provided below:

All community members and service providers who participated in qualitative interviews; Sergio Caraballo, Sofia Mendez, Buena Gente Community Fund; Joshua Johnson, Green County Board of Health; Tegan Boehmer, Rachel Kaufmann, CDC; Elizabeth Smart, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.

4.5 References

In text, number the references in order of appearance. Place reference number callouts in parentheses inside of any punctuation. Italicize the material within the parentheses only; do not italicize the parentheses themselves. Do not include a space after the comma when listing multiple reference numbers. For example: (1), (2,3), (1–3).

In the References section at the end of the report, list references in numeric order. Follow the style of ICJME Recommendations (formerly Uniform Requirements for Manuscripts), available at http://www.nlm.nih.gov/bsd/uniform_requirements.html.

Preprints should be cited as references.

Do not use the references function of MS Word or reference manager software to create the reference list.

4.6 Footnotes

Use the following footnote symbols in order of appearance: *, †, §, , **, ††, §§, ¶¶, etc. All symbols are superscripted except *. Footnote symbols should be placed outside of any punctuation except semicolons and colons. For example: “The study identified one patient with condition X,** and two patients with condition Y.††”

Each footnote should be ≤80 words; the maximum length of all footnotes combined is 700 words.

Each footnote callout may only be used once in the body of the report.

Do not use the endnotes function of MS Word to create footnotes.

4.7 Summary Box

The Summary Box contains the key public health message, as well as the justification for the publication. It is a shorter version of and must only contain information provided in the Abstract. Essentially, it is an abstract of the abstract. It may be written in plainer language because it might be used in social media. Active voice is preferred. Use of first person (e.g., I, we, our) and directive language (e.g., “do this,” “don’t do this”) are not permitted.

4.7.1 Summary Questions and Answers

The summary box provides brief answers (one or two short sentences each) to the three questions below. The maximum length is 125 words total (100 words total for Notes from the Field), including the three question headings.

  • What is already known about this topic? (align with background in Abstract)
  • What is added by this report? (align with results in Abstract)
  • What are the implications for public health practice? (align with public health message in Abstract and conclusion of report)

4.7.2 Summary examples

Below are two summary box examples that meet the requirements. Authors can refer to published reports for additional examples.

Summary

What is already known about this topic?

Eight states, including Colorado, have legalized recreational marijuana use among persons aged ≥21 years. The association between marijuana use and occupational injury is of public health concern.

What is added by this report?

During 2014–2015, 14.6% of 10,169 Colorado adult workers reported using marijuana in the previous 30 days. The highest prevalences of current use were among young adults and men, and among adults working in the Accommodation and Food Services industry (30.1%) and Food Preparation and Serving occupation (32.2%).

What are the implications for public health practice?

By understanding the occupations and industries of workers who report recreational marijuana use, employers can develop appropriately targeted workplace marijuana policies and safety awareness campaigns.

Summary

What is already known about this topic?

Surveillance is the cornerstone of polio eradication efforts.

What is added by this report?

In 2017, 22 wild poliovirus cases were reported from two countries (Afghanistan and Pakistan), the fewest number ever reported globally. Polio cases caused by circulating vaccine-derived polioviruses increased from four in 2016 to 96 in 2017 because of large outbreaks in Syria and the Democratic Republic of the Congo. Although surveillance performance indicators are improving at the national level, gaps remain, including at subnational levels.

What are the implications for public health practice?

As polio cases decline, sensitive and timely surveillance becomes even more important. As long as polioviruses circulate in any country, all countries remain at risk.

4.8 Tables, Figures, and Boxes

4.8.1 Tables

  • Create tables in MS Word or Excel.
  • Submit each table as a separate file; do not embed tables in the report text file.
  • Table titles should be descriptive and complete, including the who, what, where, and when of the data being presented, so that a reader can understand what the data represent without reading the text.
  • For tables listing epidemiologic data by geographic entity (e.g., region, division, state, locality, or city) or other categories such as race and ethnicity, MMWR prefers to publish table data with categories sorted alphabetically unless there is a clear low-to-high or high-to-low pattern that should be highlighted.
  • Tabs should not be used to create table columns or entries, and individual entries should appear in their own individual cells rather than separated by hard returns.
  • Cells cannot be empty. To address, cells can be merged (e.g., works well for row and column headings), can include an em-dash as a placeholder for a numeric value, or can include indication that value was not calculated.
  • Cells cannot contain hard returns, tabs, or extra spaces.
  • Confidence intervals should be reported as a range within parentheses (e.g., (200–400)). Do not report as a numeral followed by a ± symbol (e.g., 300±100).
  • Numbers and related percentages or confidence intervals should be placed in the same cell, not in separate columns.
  • Footnote symbols should be placed sequentially in the table, beginning with the title and then moving • from left to right, row by row in the table. Use the following footnote symbols in order of appearance: *, †, §, , **, ††, §§, ¶¶, etc. The * symbol is not superscripted; all other symbols are superscripted.
  • Footnote callouts may be used more than once in a table.
  • Table footnotes do not count against the footnote limits for the text of the report.
  • Authors can review tables in recent (current or past year) online reports for style.

4.8.2 Figures

Submit each figure as a separate file; do not embed figures in the report text file.

Figure titles should be descriptive and complete, including the who, what, where, and when of the data being presented, so that a reader can understand what the data represent without reading the text.

4.8.2.1 Types of Figures
  • Diagrams and medical illustrations
  • Charts and graphs
  • Maps
  • Photographic images
4.8.2.2 Figure Instructions
  • All figures except photos should be created and submitted in vector format files such as .ai, .eps, and .wmf.
  • Photos should be submitted as high-resolution raster image format files such as .tif or .jpg.
  • Do not submit a figure with more than four panels. Panels in multipanel figures should be related to each other.
  • Place key or legend within figure whenever possible.
  • Footnote symbols should be placed in the title, not within the figure. Use the following footnote symbols in order of appearance: *, †, §, , **, ††, §§, ¶¶, etc. The * symbol is not superscripted; all other symbols are superscripted.
  • Figure footnotes do not count against the footnote limits for the text of the report.

Charts, Graphics, and Maps

  • Bar and line graphs should have linked, underlying data tables.
  • Files created by vector programs are best for accurately plotting and maintaining data points. MMWR is unable to use file formats native to statistical software applications to prepare figures for publication; most statistical software programs allow users to save or export files in digital vector formats.
  • Acceptable file formats are Adobe Illustrator (.ai), .eps, PowerPoint (.ppt), Excel (.xls), .wmf, Word (.docx editable not pasted into), .svg, and .pdf.
  • Bar and line graphs should have linked, underlying data tables.
  • Do not use pie charts or 3D graphs.

Photographic images

  • Images created digitally (by digital camera or electronically created illustrations) must meet the minimum resolution requirements (≥300 ppi) at the time of creation. Electronically increasing the resolution of an image after creation causes a breakdown of detail and will result in an unacceptable poor-quality image.
    • Each component of a composite image must be uploaded separately at submission and individually meet the minimum resolution requirement.
    • Color photographs should be submitted in RGB mode using profiles such as Adobe RGB or sRGB. Digital cameras capture images in RGB. Do not change any color settings once the file is on the computer.
    • Black-and-white photographs (e.g., radiographs, ultrasound images, CT and MRI scans, and electron micrographs) may be submitted in either RGB or grayscale modes.
    • Acceptable file formats are Photoshop .psd or .tif, and .jpg.

4.8.3 Boxes

Nonquantitative information unsuitable for tables or figures can be submitted as boxed text (typically a bulleted list). During review and production, editors will make a final determination on the format of the information.

5.0 Clearance, Submission, and Acceptance

5.1 Clearance

Reports, including any supplementary tables and figures, with at least one CDC author must be cleared at CDC before submission to MMWR. Proof of completed clearance should accompany the submission of the documents. The corresponding CDC author should ensure that the documents have received clearance from the following entities:

  • All entities that are required to clear the report in accordance with the current CDC Clearance Policy.
  • Local and state health departments involved in the investigation or analysis (for states, usually the state epidemiologist).
  • Other federal agencies named in the report or that have a programmatic or regulatory interest in matters mentioned in the report.
  • Private-sector organizations, international health agencies, ministries of health, and other organizations at which any named author is employed, according to the clearance policies for that organization, agency, or ministry.

5.2 Submission

In accordance with ICMJE recommendations, authors must state if any artificial intelligence (AI)–assisted technologies (e.g., large language models, chatbots, or image creators)  were used in the development of their submitted work. In both the cover letter and submitted work, authors should describe their use of this technology. Authors should carefully review and edit the result, because AI can generate authoritative-sounding output that can be incorrect, incomplete, or biased. Authors should assert that there is no plagiarism in their paper, including in text and images produced by the AI. Humans must confirm that there is appropriate attribution of all quoted material, including full citations.

Authors must adhere to guidance outlined in the Author Submission Checklist at https://www.cdc.gov/mmwr/pdfs/author_checklist.pdf.

The corresponding author should submit the final, cleared report through MMWR ScholarOne Manuscripts. In separate attachments, the author should send the following items:

  • Evidence of CDC clearance (if there is a CDC coauthor),
  • The text, tables, figures, or boxes
  • ICMJE disclosure of interest forms for all authors who are individually named on the byline.

Unless MMWR has agreed to expedite publication, reports should be submitted at least 5 weeks (35 calendar days) before the desired Friday issue date.

5.3 Acceptance

MMWR editors determine acceptance of submissions. Submissions that do not include CDC staff authors are first sent to CDC subject matter experts for opinions on suitability and relevance for MMWR. If a report has at least one CDC author and has received CDC clearance, it should be submitted as a CDC report and not as a non-CDC report, even in the case where the submitting and corresponding author is not a CDC employee

6.0 Scheduling and Editing

6.1 Scheduling

After a report has been accepted for publication, MMWR will assign a publication date, subject to author availability. In general, it takes approximately 5 weeks from submission to publication of a full report. During a large-scale public health emergency, this timeline can be extended for submissions unrelated to the emergency.

MMWR might agree to publish certain urgent reports on an expedited timeline. Submission deadlines for reports that MMWR has agreed to expedite are established on an individual basis.

  • To request expedited publication, the Center Director from which the report originates must submit a request to the Editor-in-Chief (Charlotte K. Kent, [email protected]) and copy the Lead Technical Writer-Editor (Teresa Hood, [email protected]).
  • The request must include the rationale for expedited publication.

To assist programs and MMWR in planning and scheduling (e.g., in conjunction with health observances such as World AIDS Day), MMWR will, at times, issue tentative publication dates for reports that have not yet been accepted for publication.

6.2 Editing

After a report is accepted and scheduled, MMWR technical writer-editors begin the final editing and production process, with responsibility of ensuring that reports conform to established editorial and MMWR style and format conventions. Changes made during this process might differ from edits and revisions made during the clearance, review, and acceptance processes and from previously published MMWR reports.

7.0 Submitting Supplementary Tables and Figures

Supplementary tables and figures are placed in CDC Stacks for online access and are not published with the report. Authors can submit up to three supplementary tables and figures to MMWR with their report. Alternatively, MMWR editors can suggest that content submitted with the report is more appropriate as a supplementary table or figure. No other type of supplementary material is accepted. Supplementary tables and figures are named inline in the report text; they are not cited in the references or footnotes sections.

The corresponding author is responsible for

  • Ensuring that supplementary materials are 508 compliant (i.e., complies with Section 508 of the 1998 amendment to the Rehabilitation Act).
  • Updating supplementary materials based on feedback from MMWR science and technical writer-editors.
  • Submitting supplementary materials in CDC Stacks.

The corresponding author should begin the CDC Stacks process as soon as a technical writer-editor has been assigned to the report. Below are the steps involved:

  • MMWR technical writer-editor sends the corresponding author the CDC Stacks form with needed information (i.e., title of report, publication date of issue, volume and issue number, and date and time when materials need to go live).
  • Corresponding author submits request and form to CDC Stacks as soon as possible and copies the technical writer-editor.
  • CDC Stacks personnel sends URLs for the supplementary materials to the corresponding author.
  • Corresponding author sends URLs to technical writer-editor to include in the report text.

The assigned MMWR technical writer-editor

  • Is not responsible for editing supplementary materials placed in CDC Stacks.
  • Might make formatting or editing suggestions to the author to ensure readability and consistency with the report.
  • Is available to answer any questions related to the process.

8.0 Prepublication Sharing of MMWR Reports

8.1 Authors

To preserve the integrity of MMWR publications, authors should not disclose a submitted report’s title, content, or expected date of publication to others or the media before the embargo lifts. Typically, the embargo lifts and reports are posted on the web on Thursday at 1:00 p.m. Eastern Time.

  • Authors may only share the report with specialists who develop communications materials for their organization, with two restrictions:
    • The communications specialists should not release their communications materials to the media before 4:00 p.m. Eastern Time on a Wednesday before a regular Thursday web posting and 2 hours before web posting of an Early Release.
    • The media should be reminded of the time that the embargo lifts and that prepared communications materials can only be shared after this time.

8.2 Media

To give reporters time to research and develop accurate materials and consult appropriate experts per ICMJE best practices, CDC’s Office of Communications shares an embargoed MMWR media package (e-book [the articles] and communication materials) when it becomes available (typically Wednesday afternoon).

Communication materials should not be shared with media before the timelines stated above unless granted previous permission from MMWR.

8.3 Partner organizations

Communication materials should not be shared with partner organizations before the timelines stated above for media unless granted previous permission from MMWR.

If a trusted partner organization requires advance notice or limited preview of a forthcoming publication, authors must consult with the MMWR health communications team at [email protected].

9.0 Guidance for Correcting Post-Publication Errors

Corrections of errors preserve the integrity of the scientific and public health literature. They also protect the reputations of authors, the MMWR Series, and CDC by demonstrating the commitment to ensuring accurate science in MMWR.

9.1 Errors Related to Small Portions of Text, Figures, or Tables

Requests to publish corrections should be sent to your report editor, who will consult the managing editor to determine if an erratum is needed. If an erratum is needed, your report editor will draft it for your review and will schedule it for publication in the Weekly as soon as possible.

9.2 Pervasive Errors Throughout the Text, Figures, or Tables

If pervasive errors are brought to the attention of authors or MMWR editors, it’s our obligation to transparently correct the literature. MMWR follows recommendations of the International Committee of Medical Journal Editors and the Committee on Publication Ethics (COPE). After reviewing the nature and source of the errors for each case, MMWR will assess the report in collaboration with the CDC Office of Science and other CDC leadership, as indicated. In cases with suspected scientific misconduct, the Office of Science will determine the appropriate corrective action. In cases of inadvertent, pervasive errors, the MMWR Editor-in-Chief will determine the appropriate method for correcting the report based on current scientific publication guidance. Below are the most likely paths for correcting inadvertent, pervasive errors.

For reports with pervasive errors but the corrections do not change the conclusions or interpretation of the report, MMWR will correct the literature through the mechanism of “Correct and Republish.” MMWR will follow National Library of Medicine guidance to ensure transparency and clarity for readers (https://www.nlm.nih.gov/bsd/policy/errata.html).

For reports that have pervasive errors that change the interpretation or the conclusions when corrected, MMWR will correct the literature through the mechanism of “Retraction.” In collaboration with authors, MMWR will determine whether it is appropriate to also republish the report at the time of retraction, and MMWR will follow National Library of Medicine guidance to ensure transparency and clarity for readers.

NOTE: If pervasive errors have been identified, contact the Editor-in-Chief at [email protected] and the Editor (Weekly) at [email protected] as soon as possible.

10.0 Contact Information

Mailing address: Editor-in-Chief; Executive Editor; Editor (Weekly); Managing Editor; or Lead Technical Writer-Editor (Weekly), MMWR Office, Mailstop V25-5, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333.

Editor-in-Chief: Charlotte K. Kent, [email protected], 404-498-0576.

Executive Editor: Rachel Gorwitz (Acting), [email protected], 404-639-8323.

Editor (Weekly): Jacqueline Gindler, [email protected], 404-498-6445.

Editor (Weekly): Paul Siegel, [email protected], 404-906-9792.

Managing Editor: Terisa F. Rutledge, [email protected], 404-498-2371.

Lead Technical Writer-Editor (Weekly): Teresa Hood, [email protected], 404-498-2852.