Appropriateness

The Medical Surveillance Monthly Report is dedicated to reporting evidence-based estimates of the incidence, distribution, impact, or trends of illness and injuries among members of the United States Armed Forces and other beneficiaries (e.g., family members, retirees, civilian employees) of the Military Health System. MSMR reports generally focus on data or public health information directly relevant to the health, safety, and well-being of MHS beneficiaries or military members’ operational readiness. Submissions with a focus beyond the U.S. Armed Forces may be considered if relevant and generalizable to a current military health issue.

Quality

Submissions should follow the general structure and reporting standards for epidemiological studies and surveillance reports, adhering to criteria specific to the study design or report type. Objectives should be clearly stated and specific. Data analyses should use standardized, validated, and accepted scientific methods with sufficient data samples to adequately address the objectives of the report. Results should be interpreted with an ultimate aim of presenting accurate and potentially actionable public health information (e.g., policy changes, practice or areas for further research). Conclusions should result directly from evidence presented and reflect the stated intention of the study design. Any significant limitations due to data quality should be included. Reports that are primarily descriptive (i.e., not testing a proposed hypothesis) should discuss results within relevant context (e.g., setting, existing knowledge or literature, etc.) and not overstate the significance or implications of their findings. Use of active voice, in addition to succinct language, are strongly encouraged.

Originality

Reports must be submitted exclusively to MSMR, with original analysis, otherwise unpublished in the peer-reviewed literature, either previously or in the future. As part of the submission package, all prior related publications and presentations must be disclosed, including presentations (oral or poster) at scientific conferences or technical publications internal to a governmental agency. Updates of surveillance summaries previously published in MSMR will be considered if they add significant new information.

Timeliness

Reports should employ the most current data available from surveillance systems or analyses of electronic health records, surveys, case reports, or other studies. Data from emergency response or outbreak investigations should be no older than 12 months at time of submission. Generally, data presented as a Full or Brief Report should include a recent surveillance period preferably within the last 10 years, with a rationale provided for the chosen timeframe.

Clarity

Reports should be organized according to the specifications for each report type and logically developed throughout all sections. Use of acronyms should be minimized, as much as possible.

Full Reports

Full Reports present the verified results of a completed epidemiological investigation or study that answers a question of military health importance. All Full Reports are submitted to two voluntary, independent reviewers for peer review. The Introduction, Methods, Results, and Discussion sections of a Full Report should not exceed 2,500 words. Full Reports exceeding 2,500 words may be considered if supported justification is presented. Cited references are recommended to be limited at 25. Data tables and figures should complement the text succinctly and logically.

Full Reports comprise 14 elements or sections, in the following order:

1. Title: Concise and informative, reflecting the main focus or finding(s) and incorporating key terms. Refrain from using colons if possible. (A title page is not necessary.)

2. Authors: List all authors immediately below the title, according to authorship guidelines in Submission Formats (see below). MSMR policy requires that all authors satisfy all International Committee of Medical Journal Editors authorship criteria:

• Substantial contributions to the conception or design of the work, or acquisition, analysis or interpretation of data for the work.
• Drafting of the work and critical revision of important intellectual content.
• Final approval of version to be published.
• Agreement to accountability for all aspects to ensure questions of accuracy or integrity are appropriately investigated and resolved.

3. Military Relevance: MSMR aims to convey actionable medical surveillance information to military medical and public health professionals for their enhancement of force health, fitness, and readiness. With a maximum of 100 words, succinctly convey what is novel about the findings and how they can inform decisions and actions to support force health protection. This information is presented in a text box with 2 key questions: What are the new findings? and What is the impact on readiness and force health protection?

• For the new findings statement, in 50 words or less, highlight, in plain English, the key findings of the analysis or report that either are new or significant within the discipline or context.
• For the impact statement, in 50 words or less describe, in plain English, how the findings can be applied to decisions or actions for military operational readiness or force health protection. See MSMR November 2018–Volume 25, Issue 11 for examples.

4. Abstract: With a maximum of 175 words, as an unstructured paragraph (i.e., containing no body section headers), summarize the report with a focus on the main findings.

5. Key Words: Please provide a list of key words for the manuscript, to maximize potential readership among those searching for resources via internet search engines, PubMed Central, or other scientific databases.

Body of the manuscript—2,500 words or less

6. Background: Include contextual information (i.e., concise review of the topic background, existing knowledge or literature, and relevant prior discussions) as they relate to the goals, expected findings and implications of the work being reported, focusing on relevance to U.S. military populations or operations. Conclude with the objective or specific question(s) the report aims to answer.

7. Methods: Specify, as appropriate, the target population, time period, definitions, exposures, outcomes or endpoints, other characteristics of interest, sources and methods of data collection, and data summary and statistical analysis methods. The Methods section must contain sufficient detail to allow reproduction or verification of the study. If the analysis involved databases or methods previously published, limited text should be devoted to such information available elsewhere, with references. Additionally, the Methods section must describe how the data were obtained, including the source(s), case and covariate definitions, and the most recent date the data sources were refreshed.

8. Results: Communicate, logically and concisely, the findings and analysis results. With the exception of emphasis on important or significant observations, do not repeat numerical data presented in tables and graphs; limit tables and figures to those required to explain and support the argument and report key outcomes identified in Methods. Descriptive studies should prioritize analyzing and presenting data that can connect findings with the identification of trends, the hypotheses generation, or guiding public health actions.

9. Discussion: Provide interpretive comments that address the importance of the study findings. Contextualize the main findings within broader military or general public health conditions or concerns, including previously published comparative studies, as applicable. Articulate both study strengths and limitations, including likely impacts of the limitations (e.g., shortcomings of data sources, sources of bias). Propose specific strategies for future studies or changes in practice. Descriptive studies should limit their discussions to noteworthy trends, strengths and limitations, and suggestions for future work without overstating the significance or implications of the findings.

10. Author Affiliations: List the affiliations of all authors immediately following the conclusion of the manuscript. 

11. Acknowledgments (optional): Recognize contributors who do not qualify as authors.

12. Disclaimers: Disclose any service-specific or DOD disclaimers. Submissions from within any DOD service or agency must receive a legal and public affairs review by the authors’ organization(s).

13. References: Cite a recommended maximum of 25, directly related to the topic of discussion. All references must be cited within the text, using superscripted notations. List references using AMA style. See Submission Formats for formatting requirements.

14. Tables and figures: The number of tables and figures should complement the text, succinctly and logically. Submit in a separate Excel file. See Submission Formats for formatting requirements.

Brief Reports

Brief Reports condense 12 of the 14 elements of a Full Report—an Abstract and Military Relevance sections are not required—to 1,000 words maximum. Brief Reports are generally suitable for most descriptive studies, due to their simplified and limited Methods and Discussion sections. Brief reports are generally limited to one or two tables and figures, with a maximum of 10 references. All Brief Reports are peer-reviewed.

TIP: Simplicity expedites the review of a Brief Report, which either summarize data analyses or provide an update on prior reporting. Example.

Outbreak Reports

Outbreak Reports detail the chronology of an epidemiologic investigation. Outbreak Reports include all 14 elements required for Full Reports and should not exceed 2,000 words. The Methods section should include details on how the event meets the definition of an outbreak. Summarize the epidemiological investigation with case definitions or case-defining activities, information on the suspected or laboratory confirmation (if available) of etiology of the outbreak and study design. The Results should provide a comprehensive description of the outbreak by describing case characteristics (e.g., clinical characteristics), as well as person, place, and event timeline measurements. The Discussion may include a brief summary of public health interventions, interpretation of results, implications for public health practice, and recommendations for future prevention and control. All Outbreak Reports are peer-reviewed.

TIP: This type of report may include clusters of disease where no specific etiology was discovered after a thorough investigation. Example.

Case Reports

Case Reports, limited to 1,000 words, describe a disease occurrence for sharing timely, pertinent, and potentially actionable information for medical, scientific, or educational purposes. Case Reports should clearly establish a relevance to matters of public health importance. Case Reports should include a Summary of each case(s) followed by a Discussion, and may contain images, as appropriate. Specific section headers may be proposed by authors. Acknowledgments, Disclaimers, and References should be included, when applicable. All Case Reports are peer-reviewed. Example.

Surveillance Snapshots

Surveillance Snapshots depict the incidence or distribution of disease in a single chart. Surveillance Snapshots can include one or two paragraphs of text (with no section heading), limited to 500 words. Surveillance Snapshots are not peer-reviewed but are subject to editorial review that may include consultation with other AFHSD staff. Acknowledgments, Disclaimers, and References should be included, as applicable. Example.

Letters to the Editor

Letters to the Editor offer timely and concise opinions or interpretations of articles published previously in MSMR. Letters should not include unpublished data and should be submitted within one year of the referenced article’s publication. Letters are not peer-reviewed, but it is customary for the editorial team to send each letter to the author(s) of the original work for an opportunity to reply; the authors’ response is generally published as a companion. Text is limited to 1,000 words, with references limited to five. Tables and figures are discouraged but may be considered on an individual basis. Acknowledgments, Disclaimers, and References should be included, as applicable.

Letters are subject to abridgement and editing for style and content. Example.

Historical Perspectives

Historical Perspectives discuss the historical impact(s) of a disease or condition, on a specific military operation or the military overall. Historical Perspectives are limited to 2,000 words and can contain one or two images. The section headers can be proposed by the authors; Acknowledgments, Disclaimers, and References should be included, as applicable. Historical Perspectives may be peer-reviewed by historians or relevant subject matter experts. Example.

Notices to Readers

Notices to Readers announce changes in recommended public health practices (e.g., vaccine recommendations) or the availability of clinical or surveillance resources (e.g., laboratory testing), in 500 words or less. Notices to Readers are not peer-reviewed. MSMR does not publish meeting announcements or summaries of past meetings. Example.

Images in Health Surveillance

Images in Health Surveillance illustrate militarily-relevant public health information with photographs, drawings, or other images, with accompanying text limited to 500 words, and no section headers. Acknowledgments, Disclaimers, and References should be included, as applicable. Example.

Guest Editorials

Editorials are usually invited but may be proposed. An editorial may serve as an opinion piece, or a comprehensive narrative relevant to public health professionals serving MHS beneficiaries. This may include a narrative review of literature or knowledge base, an update on the current understanding and state-of-the art of the topic, theory, and practice of epidemiology or military public health sciences. Editorials are generally limited to 2,000 words and may contain up to 2 tables or figures. The section headers of this report may be proposed by the authors. Acknowledgments, Disclaimers, and References should be included, as applicable. Example.

Other Article Types

May be proposed in an email to the editor.

MSMR follows the American Medical Association Manual of Style, 11th edition as well as the MHS Editorial and Style Guide. Please refer to the AMA Manual if specific questions about formatting or structure are not addressed in these instructions. Submissions should be sent to the MSMR editor at dha.ncr.health-surv.mbx.msmr@health.mil.

The following items are required for submission:

• a Microsoft Word document of the manuscript text for the proposed article
• a completed Authorship Submission Form
• a completed ICMJE Disclosure Form
• a Microsoft Excel file containing any associated tables and figures, or associated images, as applicable.

Manuscript Text

All manuscript text should be submitted in one Microsoft Word file, using the structure and section headers (if applicable), as noted for each Type of Report. Please submit all Word documents in 12-point Times New Roman font, with text double-spaced, and leave right margins unjustified (ragged). Do not embed tables or charts in the Word document (see Tables and Figures). A title page is not required.

Word limits only apply to the body of the text (i.e., exclude Title, Authorship, Structured Abstract, References): 2,500 words for Full Reports; 2,000 words for Outbreak Reports, Topical Reviews, and Historical Perspectives; 1,000 words for Brief Reports and Case Reports; and 500 words of text may accompany Surveillance Snapshots, Images in Health Surveillance, and Notices to Readers, Submissions longer than these suggested word counts will be considered individually and must be justified by the authors in their submission e-mails.

Standard usage specified by MSMR (that may be adjusted during the editorial process) includes:

• All numbers in the text should be expressed in numeral form, including one (e.g., as 1), except when the first word of a sentence; this is in accordance with AMA guidelines. 
• “Female” and “male” are adjectives to modify another category, e.g. “female service members” or “male participants,” with the terms “women” and “men” used in nominative references to sex category or specific individuals.
• Per AMA Manual of Style Correct and Preferred Usage, specified racial and ethnic terms are preferred over collective terms, when possible. When collective terms are employed, categorization of race and ethnicity as “race/ethnicity” is not recommended; instead, “race and ethnicity” is preferred, as numerous subcategories may exist within race and ethnicity. All specified races or ethnicities should be capitalized (e.g., Black, Hispanic, White, etc.). 
• Because “impact” is specific medical terminology (related to impaction), MSMR uses the verb “affect” or other synonyms for the transitive verb case, per the MHS Editorial and Style Guide. 
• Health care is always written as two words in MSMR, both as a noun or adjective.

References

References should be listed in accordance with AMA style.

• List authors by last name and initials with no punctuation other than commas separating authors. When listing articles with more than six authors, list only the first three authors with “et al.”
• Only proper nouns are capitalized in article or chapter titles; all nouns are capitalized and italicized in primary source (e.g., journal, published report, book) titles.
• Use journal title abbreviations as cited in PubMed; italicize journal title abbreviations, and book and published report titles.
• Journal issue citations should include no spaces after the year of publication, which should be followed by a semicolon; then the volume number with issue number in parentheses, followed by a colon and the page number(s).
• For webpages or articles published exclusively online, if no individual authors are cited list the immediately responsible entity (i.e., office or division) for the content. Following the title of the article or webpage, list the name of the most senior entity or authority (i.e., website host organization). 
• Online updates and dates of access should precede Digital Object Identifier (DOI) or URL information. 
• Provide DOI numbers instead of URLs whenever possible, with no period after the DOI or URL listing..

Example references:

1. Webber BJ, Tacke CD, Wolff GG, et al. Cancer incidence and mortality among fighter aviators in the United States Air Force. J Occup Environ Med. 2022;64(1):71-78. doi:10.1097/JOM.0000000000002353 
2. Armed Forces Health Surveillance Division. Armed Forces Reportable Medical Events Guidelines and Case Definitions. Defense Health Agency, U.S. Department of Defense. Oct. 2022. Accessed Apr. 6, 2023. https://www.health.mil/Reference-Center/Publications/2022/11/01/Armed-Forces-Reportable-Medical-Events-Guidelines  
3. O’Connor FG, Sawka MN, Deuster P. Disorders due to heat and cold. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Elsevier Saunders;2016:692-693. [If no DOI is available, provide current URL preceded by “Accessed date)”.]

Authorship and Affiliations

The Microsoft Word file submission must include a list of all authors immediately following the Title. For each author, list first name, middle initial, last name, highest academic degree(s). Examples: John Faulkner, MD, MPH; Mary L. Archer, MD. If an author holds two doctoral degrees (e.g., MD and PhD), either or both may be used, in the order preferred by the author. List academic degrees below the highest degree only when they represent a specialized field or a field different from the one represented by the highest degree (e.g., MPH, BSN).

In separate Affiliations section, immediately following the conclusion of the manuscript, list each author’s current assignment and/or affiliation. Example: U.S. Naval Medical Research Unit 3, Cairo, Egypt: Dr. Archer; Department of Surgery, University of Chicago, Illinois: Dr. Snow, Dr. Smith, Dr. Jones.

Only authors with substantive contributions to the report who qualify for authorship credit according to ICMJE guidelines may be listed. Listing authors who do not meet ICMJE authorship criteria is considered a serious breach of scientific ethics. The primary author is solely responsible for verifying the academic contributions of each co-author. Each co-author must approve the final version of the article prior to publication. It is MSMR policy that an author must satisfy all of the following criteria:

1. Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work: For contributions to be considered substantial, the work could not have proceeded without the contributions of the author. Granting authorship to a senior individual solely by virtue of a position, e.g., department chief, commander, is prohibited. The MSMR may request additional information to verify substantial contributions.
2. Drafting of the work and critical revision for important intellectual content: Each author should provide substantive comments during the review process. Authors should record comments during the review process so each author’s contributions to the final product can be verified.
3. Final approval of the version published.
4. Agreement to accountability for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Scientific misconduct, e.g., falsifying or intentionally presenting misleading data is a serious offense, and all authors are expected to fully cooperate in any investigation where scientific misconduct is alleged.
5. The primary author must be able to identify which co-authors are responsible for specific parts of the work. This information should be included in the initial submission packet verifying authorship.

In accordance with ICMJE guidelines, authors should disclose whether they used Artificial Intelligence (AI)-assisted technologies to produce any portion of the submission. Contributions from AI-assisted technologies should be acknowledged in an appropriate section of the submission. For example, if AI was used for data collection, analysis, or figure generation, authors should describe this contribution in the methods. If AI was employed for writing assistance, this should be noted in the acknowledgment section. The AI software name, program or tool, version and extension numbers, manufacturer, and dates of use should be acknowledged. Authors are fully responsible for the accuracy, integrity and originality of work; thus, AI may not be listed as an author or coauthor. Authors should carefully review any AI contribution to assure the submission is free from plagiarism in text and images.

Tables and Figures

Tables and figures must be submitted as a separate Microsoft Excel file, not embedded in the text. Authors should study tables in recent MSMR reports for style. Microsoft Excel is the preferred software for generating tables and figures. Figures generated using other software (e.g., SAS, SPSS) will be considered on an individual basis.

TIP: Authors should study tables in example and previously published reports for specific style guidance.

Photographs that illustrate a prevention intervention, risk factor, or outbreak setting are encouraged. Only submit photographs within the public domain; if a photo credit is required, submit the name with the photograph..

Services and Agencies

Prior to submission, authors must initiate clearance processes from their respective services or agencies and from human subjects review boards, as appropriate. Manuscripts pending clearance may be submitted to MSMR for consideration, but publication will be deferred indefinitely until ALL clearance documentation is received by the MSMR staff. Authors should check with their individual departments to ascertain if additional clearances need to be obtained from agencies outside their normal chain of command. Clearance documentation is required for all named authors on the manuscript, not just the corresponding author. If the respective service or agency requires statements to be published with the manuscript, this should be included under the Disclosure section.

Consent of co-authors

Corresponding authors must obtain written approval from all co-authors consenting to publish the report with their names listed as an author. Written consent may be obtained in the form of e-mail messages from each author saying that they approve publication of the report.

Authors submitting to the MSMR are expected to observe high standards of publication ethics as set out by the International Committee of Medical Journal Editors and the World Association of Medical Editors. Falsification or fabrication of data, plagiarism, misappropriation of work, and ghost writing are all unacceptable. Cases of ethical misconduct are treated very seriously and will be dealt with in accordance with ICMJE guidelines.

1. Authorship: Authorship should be limited to those who have made a substantial contribution to the conception, design, execution, analysis, or interpretation of the reported study. Individuals claiming authorship should meet all four criteria specified in the ICMJE author guidelines. Upon submission, authors are asked to sign the Authorship Criteria Form outlining each authors’ contribution and designating a single corresponding author. All authors are required to submit written statements of approval acknowledging their review and approval of the accepted article. 
2. Originality: By submitting a manuscript to MSMR, the authors affirm that it is an original manuscript, is unpublished work, and is not under review by another journal. Previous publication of an abstract as part of a scientific meeting does not preclude subsequent submission for publication in MSMR. Publication as an academic thesis or as an electronic preprint also is not viewed as prior publication. Full disclosure should be made to MSMR editorial staff, however, upon submission. 
3. Plagiarism: MSMR will treat plagiarism (using the language, ideas, or thoughts of another as your own without attribution or permission) extremely seriously. 
4. Conflict of interest and financial disclosure: In the interest of transparency, MSMR requires the disclosure of all relationships, activities, and interests related to the content of a manuscript through a standardized document maintained by ICMJE. “Related” means any relation with for-profit or not-for-profit third parties whose interests may be affected by the manuscript content. Conflicts of interest will not necessarily disqualify a paper or an author; full disclosure allows an informed and reasonable decision by the MSMR editorial staff. Contact the MSMR Editor with any questions about a possible conflict of interest.  
5. Data access and retention: For reports submitted by authors not affiliated with AFHSD, raw data used for analysis may be necessary for editorial review and authors should be prepared to provide access to such data, within the limits of a data sharing agreement (if required) and subject to safeguards of personally identifiable information specified by the Privacy Act of 1974, HIPAA, and amendments to these laws. Requests for data used to generate reports within AFHSD should be directed to dha.ncr.health-surv.mbx.afhs-ea-reports@health.mil; such requests for data or analysis must be submitted by a military service member or government employee working for a U.S. military organization. Requests for Defense Medical Surveillance System data will be evaluated individually, and those requesting such data may be required to obtain a data sharing agreement with DHA’s Privacy and Civil Liberties Office.  
6. Acknowledgment of sources: The work of others must always be properly acknowledged. 
7. Fundamental errors in published works: Authors must promptly notify the MSMR of any significant errors or inaccuracies in the published work and must cooperate with the editorial staff to retract or correct the paper.  
8. Reporting standards: Authors should present an accurate account of any original research and an objective discussion of its significance.  
9. Hazards and human or animal subjects: Compliance statements are needed if the research involves animal or human subjects or if it involves chemicals, procedures, or equipment that have unusual hazards inherent to their use.  
10. Use of patient images or case details: Ethics committee approval and informed consent for research on patients or volunteers should be included in the paper.

Managing Allegations of Misconduct

Authors bear sole responsibility for the content and opinions expressed in their paper. Allegations of possible misconduct will be handled on a case-by-case basis. Allegations regarding manuscripts in progress will result in the manuscript being halted while a review is performed to determine if there is enough evidence to lead a reasonable person to believe there is possible misconduct. Published manuscripts will also be reviewed if such allegations are raised, and the MSMR editorial staff will take any indicated actions to inform readers, correct the published literature, or issue a retraction as needed.

Submit to the editor via email at dha.ncr.health-surv.mbx.msmr@health.mil. Please see the Submission Formats section for all formatting requirements and instructions. Submit the Microsoft Word report document, Excel tables and figure file (or photographs, if applicable), ICMJE Disclosure Form, and Authorship Submission Form as separate attachments.

Following submission, MSMR staff will confirm receipt of the report by email. The editors will review the submission and send it for a double-blind peer review process, as appropriate. One of the following decisions will be made: Acceptance of the submission for publication and enter it into the editing and production cycle; tentatively accept it pending revision; return it for revision and subsequent consideration; or reject the submission.

Peer Review Nominations

Authors may nominate as many as three external referees to review their manuscript. Please provide their name(s) and email address(es) in the email submission to the editor. To avoid conflict of interest, the suggested referee should not be from the same department or division as any authors of the manuscript. 

Revisions

When submitting a revised manuscript, the authors’ revisions to the original text should be clearly indicated using the Track Changes feature of Word. The authors should respond to the reviewers’ comments by providing a point-by-point response to each reviewer comment provided in the Decision to Authors document. If the author accepts the reviewer comment, please describe how and where the revision was made. If the reviewer comment cannot be satisfied, please provide a rebuttal with rationale. Suggested editorial revisions involving grammar, spelling, or sentence structure do not need to be addressed in the point-by-point response.

Publication Timeline

Accepted reports are typically published within 60 days of the date of notification of acceptance.