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 of the Military Health System (e.g., family members, retirees, civilian employees). 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

Reports must be based on analyses that use standardized, validated, or accepted scientific methods and should include sufficient data samples to adequately address the aim of the report. Results should yield actionable public health information or recommendations. Recommendations presented in the Discussion should reflect the quality and nature of the study design. Any major limitations resulting from data quality should be included for transparency. Reports primarily descriptive in nature, i.e., not testing a proposed hypothesis, should have a limited Discussion section. Use of active voice, in addition to succinct language, are strongly encouraged for clarity and reports should be logically organized for ready comprehension by MSMR readers.

Originality

Reports must be submitted exclusively to MSMR, should be original, and otherwise unpublished in the peer-reviewed literature, either previously or in the future.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 and 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 surveillance period within the last five years.

Full Reports 

Full Reports present the verified results of a completed epidemiologic 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 2,000 words. Full Reports exceeding 2,000-words may be considered if a supported justification is presented to the editor. Cited references in a Full Report are limited to 25, and data tables and figures should complement the text succinctly and logically. Recommendations presented in the Discussion of a Full Report should reflect the quality and nature of the study design.

Full Report submissions comprise 10 required elements or sections, in the following order:

1. Title: Brief and descriptive, indicative of the major result(s), using as few words as possible; refrain from using colons if possible. (A title page is not necessary.)
2. Authorship and Affiliations: List all authors and affiliations immediately below the title, according to the MSMR authorship guidelines in Submission Formats. MSMR policy requires that all authors satisfy all International Committee of Medical Journal Editors (ICMJE) 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: With a maximum of 100 words, convey succinctly what is novel about the findings and describe how they can inform decisions and actions supporting readiness and force health protection: MSMR aims to disseminate actionable medical surveillance information to military medical and public health professionals to enhance health, fitness, and readiness. This information is presented in a text box with two 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, describe, in plain English, the findings of the analysis or report that either are new or provide confirmation of earlier reports.
• For the impact on readiness and force health protection statement, in 50 words or less describe in plain English how the findings can be applied to decisions or actions on behalf of military operational readiness or force health protection.  See MSMR November 2018 – Volume 25 / 11 for examples.
4. Structured Abstract: With a maximum of 175 words, summarize the report, with a focus on the main findings, in sections labeled: Introduction, Methods, Results, and Discussion.

Body of the manuscript—Maximum 2,000 words

5. Background: Include contextual information (e.g., brief, relevant literature review) and relevance to U.S. military populations or operations. Conclude with the objective or specific question(s) the report aims to answer.
6. 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. For descriptive studies, 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.
7. 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 limit analyses to those appropriate for hypothesis-generating submissions.
8. 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 (hypothesis-generating) studies should limit their discussions to new or noteworthy trends, strengths and limitations, and suggestions for future work. Analytic (hypothesis-testing) studies should include comparisons to the published literature (if any) and whether their findings confirm or refute those studies.

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

Disclaimers (optional): Disclose any necessary legal, 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).

9. References: Cite a 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.
10. 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 eight of the 10 elements of a Full Report—Military Relevance and Structured Abstract are not required—to 1,000 words maximum. Brief Reports are generally more descriptive in nature and suitable for most descriptive (hypothesis-generating) studies, due to their simplified and limited Methods and Discussion sections. All Brief Reports are peer-reviewed. Brief reports are generally limited to one or two tables and figures, to focus the scope of the report, with a maximum of 10 references.

TIP: Simplicity expedites the review of a Brief Report, which only summarize an analysis of data or prior reporting.  Example.

Outbreak Reports

Outbreak Reports detail the chronology of an epidemiologic investigation with a surveillance period of 12 months preceding the submission date. Outbreak Reports include all 10 elements required for Full Reports and should not exceed 2,000 words. The Methods section should summarize the full investigation with case definitions, case-defining activities, and epidemiologic study design. The Results should describe case characteristics (e.g., clinical characteristics) as well as person, place, and time 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 to share 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. Acknowledgements, 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. Acknowledgements, 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 previously published in MSMR. Letters should not include unpublished data and should be submitted within one year of publication of the referenced article. They 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 to the letter. Text for a letter to the editor is limited to 1,000 words, with references limited to five. Tables and figures are discouraged but may be considered on an individual basis. Acknowledgements, 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; Acknowledgements, 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. The 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, with no section headers. Acknowledgements, 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 and/or military public health sciences. Editorials are generally limited to 2,000 words and may contain up to two tables or figures. The section headers of this report may be proposed by the authors. Acknowledgements, Disclaimers, and References should be included, as applicable. Example.  

Other article types

May be proposed in an email to the editor.

The MSMR follows the American Medical Association Manual of Style, 11th edition as well as the MHS Editorial Style Guide. Please refer to the AMA Manual if you have questions about formatting or structure 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 complete Authorship Submission 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 (applicable) 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, and References), which include 2,000 words for Full Reports, 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.

References

References should be listed in accordance with AMA style.

• List authors by last name and initials with no punctuation other than commas separating each author. When listing articles with more than six authors, list only the first three authors followed by "et al."
• Only proper nouns are capitalized in article or chapter titles.
• Use journal title abbreviations as listed in PubMed and italicize journal title abbreviations and book 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 page number(s).
• Online updates and dates of access should precede the URL.
• Do not include URLs for references indexed in PubMed.

Example references:

1. Stahlman S, Oetting AA. Mental health disorders and mental health problems, active component, U.S. Armed Forces, 2007–2016. MSMR. 2018;25(3):2-11.
2. Armed Forces Health Surveillance Division. Armed Forces Reportable Medical Events Guidelines and Case Definitions. October 2022. Accessed April 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. Philadelphia, PA: Elsevier Saunders; 2016:692-693.

Authorship and Affiliations

The Microsoft Word file submission must include a list of all authors and their affiliations, immediately following the Title. For each author, list first name, middle initial, last name, highest academic degree(s). Examples: John Snow, 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). List each author’s current assignment and/or affiliation. Examples: U.S. Naval Medical Research Unit 3, Cairo, Egypt (Dr. Archer); Department of Surgery, University of Chicago, 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.

Tables and Figures

Tables and figures should adhere to AMA style and must be submitted as a separate Microsoft Excel file, i.e., not embedded in the text. Authors should study tables in previous 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.

Each table/figure should comprise one worksheet. The data used to create a figure in Excel must be included in tabular form and link to the figure. Number each table and figure and provide a descriptive title for each.

Every table and figure should be cited within the text. Verify that data are consistently reported within all text, tables, and figures.

Place legends within the figure—line labels for graphs are preferred—and titles above the figure. Do not use pie charts or 3-D graphs. Format all tables and figures with Arial font 8 point. Use lowercase superscripted letters (e.g., a,b,c) for footnotes in tables and figures.

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 photo.

Services and Agencies

Prior to submission, authors must initiate clearance processes from their respective services/agencies and from human subjects review boards, as appropriate. Manuscripts pending clearance may be submitted to the 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.

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 will be asked to sign the Authorship Criteria Form outlining each authors’ contribution and designating a single corresponding author. In addition, all authors are required to submit written statements of approval indicating that they have seen and approved the manuscript.
2. Originality: By submitting a manuscript to the 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 the proceedings of meetings does not preclude subsequent submission for publication in the MSMR. Publication as an academic thesis or as an electronic preprint also is not viewed as prior publication. However, full disclosure should be made to the MSMR editorial staff at the time of submission.
3. Plagiarism: The MSMR will treat plagiarism (using the language, ideas, or thoughts of another as your own without attribution or permission) very seriously.
4. Conflict of interest and financial disclosure: Authors must notify MSMR editorial staff of any potential conflict of interest. This includes, but is not limited to, financial (e.g., grants or funding from other sources) and material (e.g., equipment) support for the research. Conflicts of interest will not necessarily disqualify a paper or an author; however, full disclosure will allow the MSMR editorial staff to make an informed and reasonable decision. Please contact the MSMR Editor with any questions regarding 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. Acknowledgement 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 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/figure file (or photographs, if applicable), 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 peer review, as appropriate. One of the following decisions will be made: accept 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 one to three external referees to review their manuscript. Please provide their name and email address 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 one of the authors. 

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. If the author accepts the reviewer’s comment, please describe how and where the revision was made. If the reviewer’s comment cannot be revised, please provide a rebuttal. 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 acceptance.