Morbidity and Mortality Weekly Report (MMWR)
(Weekly)

Instructions for Contributors
(Updated February 2, 2012)

Contents

I. Criteria for Publication
II. Types of Reports
    A. Full Reports
    B. Outbreak Reports
    C. Policy Notes
    D. Notes from the Field
    E. Vital Signs
    F. CDC Grand Rounds
    G. Announcements/Notices to Readers
III. Submission Formats
IV. Clearance
V. Submission, Acceptance, and Scheduling
VI. Contact Information

1. Criteria for Publication
   1. Appropriateness. MMWR Weekly publishes information useful to readers in the public health community, private clinicians, researchers, teachers and students, and the news media. Reports are based in science (especially epidemiology) or on public health policy or practice. Recommendations contained within reports must be acceptable to CDC.
   2. Originality. Reports must contain previously unpublished information or guidelines/recommendations.
   3. Quality. Reports must be based on analyses using accepted scientific methods and must include sufficient data to adequately address the public health topic.
   4. Timeliness. Reports must contain the most current data from surveys, surveillance systems, or studies. Reports on investigations in progress or completed recently have the highest priority for publication.
2. Types of Reports
   The following types of reports are published in MMWR Weekly: A) Full Reports, B) Outbreak Reports, C) Policy Notes, D) Notes from the Field, E) Vital Signs, F) CDC Grand Rounds, and G) Announcements/Notices to Readers.
   1. Full Reports. 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. Contributors should check previously published MMWR reports similar to their submissions to determine their own optimal format and structure. Full Reports are limited to 1,400 words at submission, 10 references, and a total of 3 tables, figures, and/or boxes. (TIPS: A hallmark of MMWR reports is simplicity. These reports are intended only to summarize the analysis and recommendations, not to provide every detail. The 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 tell a casual reader what the report is about and what should be done.)
      1. Introductory paragraph. The first paragraph of a Full Report 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 and is limited to 150–200 words. The introductory paragraph should contain the following components: 1) background (what is the problem? why is this worth writing about?), 2) method of analysis (who did what, using what data, and why?), 3) key findings (summarize 1 or 2 main results and any actions that resulted), and 4) public health message (what should be done by public health practitioners or, if relevant, by clinicians or the public?). All information regarding methods, data sources and results in the introductory paragraph is repeated elsewhere in the report.
         
         Additional background (if needed). Each Full Report should be understandable by an informed medical or public health professional without special knowledge of the subject. If all essential background information will not fit in the Introductory paragraph, that background should be placed in a second introductory paragraph, before Methods.
      2. Methods. For most reports, the second section should be a concise summary (1 or 2 paragraphs) of the methods used to conduct the analysis. Important components of this section might include the sources of data, a statement of how the data were collected, case definitions or participant selection criteria, the period of study, types of specimens taken and tests performed (e.g., serology, culture, or toxicology), and statistical methods used. For survey and surveillance data, response rates should be specified.
      3. Results. The results section is a concise highlighting of the major results of the analysis. Examples might include elements of the descriptive (i.e., time, place, person) and epidemiologic results, disease trends and rates, treatments, and outcomes. Minor results from tables or figures should not be highlighted in results. Case reports and series should include details on exposure, signs and symptoms, initial diagnosis, laboratory and radiologic findings, treatment, clinical course, and outcome. Generally, data highlighted in the text also are presented in a table or figure.
      4. Actions taken. When appropriate, 1 or 2 sentences describing any control measures implemented.
      5. Reported by. Criteria for MMWR contributors are as follows:
         1. External and CDC contributors to MMWR must participate in 1) design of the scientific activity, 2) data collection or data analysis, or 3) drafting of all or major portions of the manuscript. All contributors must assume responsibility for the published version of the manuscript. Contributors should be able to defend their contribution independently. Collectively, contributors should be able to defend the design, execution, and conclusions of the report.
         2. Persons will not be listed as contributors merely by virtue of their position in an organization or by attendance at a meeting.
         3. Persons who reviewed a submission for a clearance process or who suggested revisions or limited changes to a submission will not be listed as contributors.
         4. An acknowledgments section may be used to recognize the work of persons involved in the project but who do not meet the MMWR contributor criteria.
         5. First and last names and middle initials (optional) should be used. Single highest academic degree (masters or above) should follow, then the organizational affiliation, then the location of organization where needed.
         6. MMWR attribution policy follows other CDC guidelines for authorship.

         Order of contributors should be as follows:
         External Contributors

         1. Consistent with traditional MMWR practice, external contributors are listed in the following order:
            • International contributors.
            • Private-sector contributors.
            • Local and state health department staff members.
            • Federal agency staff members.
         2. Within the above categories, agencies and organizations will be listed in the order of information provided in a report.
         3. If the number of agencies and organizations is large, the listing will be in alphabetical order.
         4. Agencies and organizations will provide the order of their individual contributors

         CDC Contributors

         1. CDC contributors are listed after external contributors by name, with affiliation limited to division and center/institute/office (C/I/O).
         2. CDC divisions will be listed in the order of their participation in the preparation and writing of the report, scientific activity, and the MMWR editorial process.
         3. CDC divisions will provide the order of their individual contributors.
         4. A C/I/O or division may list a program name only, without listing each contributor, when appropriate.
         5. EIS officers shall be listed last and with no other affiliation. The corresponding contributor shall provide the order of EIS officers.
         6. Reported by section should conclude with contact information for the corresponding contributor. (An EXAMPLE follows).

         Reported by

         Mandy K. Green, MPH, Oregon Public Health Div. Robert Harrison, MD, California Dept of Public Health. Kathy Leinenkugel, MPA, Iowa Dept of Public Health. Claire B. Nguyen, MS, Oklahoma State Dept of Health. Meredith Towle, Colorado Dept of Public Health and Environment. Todd Schoonover, PhD, Washington State Dept of Labor and Industries. Terry Bunn, PhD, Univ of Kentucky. Joyce Northwood, PhD, Bur of Labor Statistics, US Dept of Labor. Stephanie G. Pratt, PhD, John R. Myers, MS, Div of Safety Research, National Institute for Occupational Safety and Health, CDC. Corresponding contributor: John R. Myers, CDC, 304-285-6005, jrmyers@cdc.gov.

      6. Editorial Note. The Editorial Note should 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. With the exception of Outbreak Reports, Full Reports should include a Limitations paragraph, typically placed near the end of the Editorial Note. The Editorial Note should conclude by stating the implications of the findings to public health practice and any recommendations for prevention and control. When appropriate, specific examples of successful public health interventions should be included. A common fault is the inclusion of recommendations that, although sound, do not follow from the analysis presented in the report.
      7. Acknowledgments. May be used to recognize the work of persons involved in the project but who do not meet MMWR contributor criteria.
      8. References. Must be limited to 10.
      9. Summary box. In 1 or 2 sentences for each, contributors should answer the following: What is already known on this topic? What is added by this report? and What are the implications for public health practice? Because these answers contain the key public health message as well as the justification for the publication, contributors should consider drafting the summary box before writing the text of the report. Consult recent MMWR reports for examples.
   2. Outbreak Reports
      These should generally follow the format of Full Reports, with some elements specific to outbreak reporting. (TIP: As much as possible, an Outbreak Report should read like a chronologic narrative; it should tell the story.)
      1. Introductory paragraph. Generally, the introductory paragraph should begin with 1 to 3 sentences establishing the existence of the outbreak or underlying public health problem (e.g., “On January 2, 2008, the Nevada State Health Division contacted CDC concerning surveillance reports received regarding two persons recently diagnosed with acute hepatitis C.”) The introductory paragraph also usually contains: 1) a statement that an investigation was conducted, when and by whom; 2) the most important finding(s); 3) the actions taken to stem the outbreak; and 4) a statement of the public health implications and actions that should be taken in response to the investigation.
      2. Investigation and results.
         1. First, present the initial investigation and its findings. This might include: 1) a description of the setting and a statement of how the outbreak came to the attention of health authorities; 2) a clinical description of the index case or initial cases; 3) initial key test results; and 4) hypothesis generation activities and results.
         2. Next, summarize the full investigation, including: 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 time, place, and person descriptive results.
         3. Next, present the methods and results of any analytic epidemiologic studies (e.g., cohort or case-control studies).
         4. Finally, provide the results of any relevant microbiologic, genetic, or toxicologic results, followed by the results of any testing of environmental samples.
      3. Public health response. When appropriate, a brief description summarizing any public health interventions taken and the results of the interventions follows.
      4. Editorial note. Same as for a Full Report, except that a Limitations paragraph might not be required for an Outbreak Report.
      5. Acknowledgments. See Full Reports.
      6. References. See Full Reports.
      7. Summary box. See Full Reports.
   3. Policy Notes
      Policy Notes are intended to announce new official policies or recommendations (e.g., from ACIP or CDC). These reports can be thought of as briefer, more immediate versions of the MMWR series, Recommendations and Reports. Maximum word count at submission is 1,400 words. Up to three tables, figures, or boxes may be included. Policy Notes contain no Editorial Note or Limitations, and a summary box is not required. Contributors should check published MMWR reports similar to their submissions, then determine the optimal format and structure for their reports. Policy Notes can vary considerably. Following is a rough guide.
      1. Introductory paragraph. The introductory paragraph should be limited to 150–200 words. It might contain all or some of 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, a brief statement of the rationale for the policy or recommendation, mention of the most important parts of the policy or recommendations, and one or two sentences stating the conclusions and the public health implications of the new policy or recommendations.
      2. Background. The Policy Note should include a paragraph after the introduction 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.
      3. Methods. Should include a summary of the methods used to establish the policy or recommendation, including answers to some or all of these questions:
         1. Who was involved in the production of the guidelines or recommendations, and how?
         2. What evidence base was considered?
         3. What was the rationale for considering this evidence base? Was other evidence excluded from consideration and, if so, why?
      4. Rationale and evidence. The Policy Note should 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.
      5. Presentation of the policy or recommendation. The policy or recommendation should state clearly when it takes effect and to whom and under what circumstances it applies.
      6. Discussion or comment. The Policy Note should comment on the likely impact of the new policy or recommendation and plans for assessment of the policy or recommendation.
      7. References. See Full Reports.
      8. Summary box. A summary box is not needed for a Policy Note.
   4. Notes from the Field
      Notes from the Field are abbreviated reports intended to advise MMWR readers of ongoing or recent events of concern to the public health community, without waiting for development of a Full Report. 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. 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 in Notes from the Field.
      1. Format. The text is limited to 350 words at submission and 3 references. No tables, figures, or boxes should accompany the text. Notes from the Field should contain a brief introduction describing the onset of the event and when and how it came to light, followed by descriptions of the investigation, magnitude and extent of the event (e.g., number of known cases or geographical occurrence), outcomes (e.g., hospitalizations or deaths), and any preliminary conclusions and actions that should be taken based on the report. Contributors should check previously published MMWR reports similar to their submissions, then determine their own optimal format and structure
      2. Reported by. Because these reports are abbreviated, attribution should be strictly limited to those persons or organizations responsible for writing the report or to whom public inquiries should be directed.
   5. Vital Signs
      Vital Signs reports are a special feature of MMWR with an established format, schedule of topics, and dates of publication. Contributors assigned to write a Vital Signs report should check previously published Vital Signs and adhere to the format of those reports, while also adhering to the general principles of Full Reports.
      1. Structured abstract (≤250 words):
         1. Introduction: Background and purpose
         2. Methods: Database, years, respondents, weighting
         3. Results: Only new findings
         4. Conclusions and Implications for Public Health Practice: Self-explanatory
      2. Text (≤1,800 words):
         1. Information already available in print or electronically should generally be described in the Introduction or Conclusions, whichever is more appropriate.
         2. Methods should focus briefly on the nature of the database, respondents, response rate, analytic approach, and statistical methods used. Because methods involved in the analysis of national databases have generally been previously published, only limited text should be devoted to information available elsewhere, with methods references provided.
         3. Results should include only new findings. This includes new analyses that have not yet been published that use unpublished or published databases or summaries. The latter two categories include, for example, public use data tapes and annual or interim surveillance summaries. However, the results should not simply include already published analyses, but rather, new findings made evident by original analyses conducted by the authors.
         4. Conclusions and Comment should highlight the one or two main findings of the results and put them into context. Such context would include previously published comparative studies and limitations. This section must include the implications of these findings for public health: need for new or reinforced local/state/national programs, state/federal legislation or regulation, activities appropriate to a variety of different groups, and special attention needed for high-risk groups.
         5. References should be limited to 15.
         6. Tables and figures should be limited to a total of four.
   6. CDC Grand Rounds
      CDC Grand Rounds reports are another special feature of MMWR, dedicated to describing recent Grand Rounds presentations. These reports should be limited to 1,800 words at submission, 15 references, and a total of 3 tables, figures, and/or boxes. Contributors should check previously published CDC Grand Rounds and use them as a general guide for their reports.
   7. Announcements and Notices to Readers
      1. Announcements describe upcoming training courses, conferences, publications, and public health events (e.g., World AIDS Day). Maximum length is about 150 to 250 words. If an Announcement of a public health event is accompanied by a Full Report on a directly related topic, and that report is selected for the cover of the issue, the Announcement may be published in a box on the cover.
      2. Notices to Readers are used generally to inform MMWR readers about changes in MMWR content, policies, and features, but also may be used to update certain information in previous MMWR reports.
3. Submission Formats
   1. Text. Submit in Microsoft Word. Maximum length of reports varies by report type and does not include title, reported by, footnotes, references, and acknowledgments.
   2. References. Follow the style of Uniform Requirements for Manuscripts Submitted to Biomedical Journals (available at http://www.icmje.org). In text, place reference number “callouts” in parentheses and italicize the numeral only “(1).” Number references within the text in order of appearance, then list in numeric order at end of report. Do not submit with Reference Manager engaged.
   3. Tables and Figures. Tables should be created in Word table function or in Excel. Contributors should study tables in previous reports for style. Tables cannot have tabs or extra spaces within the cells. Tables should be sent in separate files and not embedded in text. For tables listing epidemiologic data by geographic division (e.g., state, locality, city), MMWR prefers to publish table data sorted by performance. Figures should be created in (not pasted into) Corel Draw, PowerPoint, Excel or (in the case of maps) vector format files (such as .cdr, .cgm, .eps, and .wmf). Bar graphs or line graphs should have underlying data tables. Figures should be sent in separate files and not embedded in text. Place keys/legends within the Figure.
   4. Footnotes. For footnotes, do not submit with the endnotes function of MS Word engaged. Use the following footnote symbols in order of appearance: *, †, §, ¶, **,††, §§, ¶¶, etc. The * symbol is not superscripted. All others are superscripted.
4. Clearance
   MMWR publishes only reports that have been cleared according to CDC and MMWR clearance policies. Before submitting reports to MMWR for publication, contributors should ensure that reports have received 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 a programmatic interest in the report’s topic.
   4. Other federal agencies named in the report or that have a programmatic or regulatory interest in matters mentioned in the report.
   5. 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 that organization, agency, or ministry.
   6. MMWR will initiate CDC clearance for those reports submitted from outside CDC.
5. Submission, Acceptance and Scheduling
   1. Unless MMWR has agreed to expedite publication, cleared full reports should be submitted at least 23 calendar days before the Friday issue date. Generally, Announcements/Notices to Readers should be submitted 11–14 calendar days before the Friday issue date. Submission deadlines for reports that MMWR has agreed to expedite (i.e., Dispatches or Early Releases) are established on an individual basis.
   2. NOTE: Contributors and programs must notify CDC’s Office of the Director (i.e., CDC Director and Principal Deputy Director) if a Dispatch or Early Release is being submitted to MMWR for expedited publication. As a courtesy, MMWR also notifies the CDC Office of the Director of forthcoming expedited reports.
   3. All reports must be accepted for publication by the Editor. MMWR determines acceptance for publication after reviewing the final, cleared report. Contributors who wish to discuss a proposal or concept with the Editor prior to writing a report are encouraged to do so, but this is not a mandatory step and will not guarantee subsequent acceptance.
   4. After a report has been accepted for publication, MMWR will assign a publication date, subject to contributor availability. To assist programs and MMWR in planning and scheduling (e.g., in conjunction with health observances like World AIDS Day), MMWR will, at times, issue tentative publication dates for reports that have not yet been accepted for publication.
   5. Contributors should e-mail their final, cleared report to the Lead Technical Writer-Editor at dweatherwax@cdc.gov or to MMWR Editors at editorsmmwr@cdc.gov. In the same e-mail, in separate attachments, contributors should send evidence of CDC clearance and the text, tables, and figures.
6. Contact Information
   1. Mailing address: Editor, Deputy Editor, or Managing Editor, MMWR Office, Mailstop
      E-90, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333.
   2. Editor, Ronald Moolenaar, e-mail: rmoolenaar@cdc.gov; telephone: 404-498-0576.
   3. Deputy Editor, John Moran, e-mail: jmoran@cdc.gov; telephone: 404-498-6445.
   4. Deputy Editor, Christine Casey, e-mail: ccasey@cdc.gov; telephone: 404-498-6621.
   5. Managing Editor, Teresa Rutledge; e-mail: trutledge@cdc.gov; telephone: 404-498-2371.
   6. Lead Technical Writer-Editor, MMWR Weekly, Doug Weatherwax; e-mail: dweatherwax@cdc.gov; telephone: 404-498-2365.
   7. MMWR office fax: 404-498-2389.