MAHC Scope, Principles, and Style Guidance

Writing for the MAHC

Suggested edits to the MAHC, including change requests submitted to CMAHC, should conform to the scope, principles, and style guidance outlined by CDC.

MAHC Program Goal: 

Healthy and safe aquatic experiences for everyone.

MAHC Terms of Reference: 

Starting in 2007, CDC worked with a national collation to develop the MAHC and released the MAHC 1st Edition in August 2014 with subsequent new editions published in 2016 and 2018. To keep the MAHC up to date with the latest public health data and design innovations, CDC partners with the CMAHC multi-disciplinary, multi-sectoral membership to receive the member voting results on proposed change request to the MAHC. As sole owner of the MAHC and in order to use CDC’s logo and publicly post the CMAHC on CDC’s website, CDC reserves the right to change the MAHC code but will work with the CMAHC to do so. In addition, CDC reserves the right to review each CMAHC change request and accept or reject the change request proposal: CDC will release the rationale for any decision to reject a CMAHC change request proposal decision.

MAHC Scope:

The MAHC’s scope includes all public man-made aquatic facilities or venues. Aquatic venue means an artificially constructed structure or modified natural structure where the general public is exposed to water intended for recreational or therapeutic purpose and where the primary intended use is not watering livestock, irrigation, water storage, fishing, or habitat for aquatic life. Such structures do not necessarily contain standing water, so water exposure may occur via contact, ingestion, or aerosolization. Examples include swimming pools, wave pools, lazy rivers, surf pools, spas (including spa pools and hot tubs), therapy pools, waterslide landing pools, spray pads, and other interactive water venues.

The scope covers the aspects of all public aquatic facilities and venues relating to the design, operation and policies that can impact the health and safety of the aquatic facility or venue users or occupants. This impact can be a result of venue design, venue water quality, aquatic facility air quality, and aquatic facility/venue operations and management. The MAHC is not intended to replace existing codes or standards that cover other aspects of aquatic facility or venue design or operations where standards otherwise apply (e.g., electrical code, plumbing code) or impinge on the regulatory authority of other government jurisdictions that regulate and/or inspect certain aspects/parts of aquatic facilities where existing standards are otherwise applicable (e.g., amusement rides/slides).

MAHC Code Changes:

CDC will limit any changes to MAHC code sections 3 through 6 that are not part of CMAHC change request process. However, CDC reserves the right to not accept a change request if CDC determines it does not serve public health or is not supported by the data or best practices submitted. CDC reserves the right to alter MAHC code sections 1 and 2 but still encourages submission of change requests. CDC encourages MAHC Code changes that also include supplemental annex language.

MAHC Annex Changes:

CDC reserves the right to alter the MAHC Annex as needed to keep it up to date and relevant. The scale of potential changes needed in each revision cycle makes it necessary for CDC to make changes as necessary. However, CDC still strongly encourages submission of CMAHC change requests, particularly with new or expanded and appropriately referenced sections to add to the Annex. CDC considers the Annex a living reference document and solicits input on improvements.

MAHC Principles:

  1. Provide guidance on how state and local officials can transform a typical health department pool program into a data-driven, knowledge-based, risk reduction effort to prevent disease and injuries and promote healthy recreational water experiences.
  2. Evolution not revolution. We strive to incrementally improve systems to allow regulatory and industry partners to adapt to MAHC guidance.

MAHC Style:

  1. For enforcement, inspection, discussion, and MAHC indexing purposes, the MAHC is written to keep different enforceable elements separate under different section numbers. CDC discourages editorial requests that consolidate elements solely for reading or brevity purposes.
  2. MAHC guidance may be repeated in different areas to ensure users don’t miss guidance and because guidance may have to be worded differently (e.g., lists may be in operational areas as well as training areas) so deletions due to “repetition” are not warranted.
  3. Code language must be enforceable so wording is generally directive and imperative. The MAHC uses “shall” vs. other words such as “may,” “must,” or “should consider” that are not enforceable by public health officials.
  4. It is preferable and more efficient to consider whether a desired need can be met by referencing another code (NEC, fire code, plumbing code, etc.) rather than adding new wording to the MAHC. Wording should be added only if no such reference exists or the MAHC does not consider that existing standards adequately cover what is needed.
  5. Clarification of wording is preferable to deletion of entire sections thought to be unclear.
  6. Prose Writing
    • Only 1 space after period.
  7. Spelling
    • The following words are always spelled as one word: childcare, handrail, handwashing, healthcare, waterslide.
    • CDC does not use the term daycare. Instead, use childcare.
  8. Small Caps
    • All glossary terms present in the Code and Annex have been denoted with small caps text. There are separate glossaries for the Code and Annex as some terms are present in one document but not the other.

Reference Format:

Preferences for linking journal articles:
    • HTML full text, if open access
    • PDF full text, if open access
    • PubMed abstract
    • Other site abstract

Look up open access status:
  • PubMed — right hand corner

Always open access:
  • MMWR
  • Emerging Infectious Diseases
  • PLoS

In-text use of references:
  • Superscript numbers on references.
    • Should link to specific reference
    • Should be located:
      • Directly by the reference or
      • After the period at the end of the referenced sentence

Citation format:
  • Format is essentially the PubMed format that is rearranged to be authors-title-citation. All references should be checked for open access (upper right corner of PubMed abstract) with link to open access first or abstract if not open access.
  • The title of the reference should be hyperlinked to open-access location or abstract in PubMed.
  • If there is a PDF then the PDF icon is inserted so it does not break the reference in half
  • The reference list at the end of the Annex will use complete references with all author names, but the footnoted references within the Annex text will only list the first author, then comma “et al”
    • Example:
      • Morgan OW, et al. Schistosomiasis among Recreational Users of Upper Nile River, Uganda, 2007. Emerg Infect Dis. 2010;16(5): 866-8.
  • Journal article format per PubMed format
    • National Library of Medicine Journal Abbreviations for journals are listed at
    • All authors listed
      • Author last name-space-author initials (no periods between initials)-comma-last author (no “&” or “and” added)-period-space
      • Full title (sentence case—NOT capitalized for each word)-period-space
      • Journal abbreviation (IOM standard, not italicized, no periods after abbreviated portion of title—i.e., Epidemiol Infect)-period-space
      • Year-semicolon-volume-(issue)-colon-full first page-dash- full last page-period
        • Example:
          • Buss BF, Safranek TJ, Magri JM, Török TJ, Beach MJ, Foley BP.  Association between swimming pool operator certification and reduced pool chemistry violations — Nebraska, 2005–2006. J Environ Hlth. 2009;71(8):36–38.
  • Article name is sentence case—caps on first word and any genus names only.
  • All species and genera names should be italicized in titles but no other italics (i.e., title, journal) are used
    • Example:
      • Golaszewski G, Seux R. The kinetics of the action of chloroisocyanurates on three bacteria: Pseudomonas aeruginosa, Streptococcus faecalis, and Staphylococcus aureus. Water Res. 1994;28(1): 207-217.
  • Web link as a reference
    • The use of a web link should also include authors, document name, and access dates for link, etc. in addition to the link.
      • Example:
        • Gipson K. Pool and spa submersion: estimated injuries and reported fatalities, 2010 Report. May 2010. U.S. Consumer Product Safety Commission. Accessed on 02/27/2011 at
  • Books as references
    • General format
      • Authors or Editors. Book title. Edition. Secondary Author (or translator). Place of Publication: Publisher; Date of Publication. Total number of pages.
        • Example:
          • Eyre HJ, Lange DP, Morris LB. Informed decisions: the complete book of cancer diagnosis, treatment, and recovery. 2nd ed. Atlanta: American Cancer Society; c2002. 768 p.
    • Book with no authors
      • Start with the title of the book
      • Format:
        • Book title. Edition. Secondary Author (or translator). Place of Publication: Publisher; Date of Publication. Total number of pages.
          • Example:
            • HIV/AIDs resources: a nationwide directory. 10th ed. Longmont (CO): Guides for Living; c2004. 792 p.
    • Parts of the book
      • Volume of a book
      • Format:
        • Author. Title of Book. Edition. Place of Publication: Publisher; Date. Name of Part Number of Part, Title of Part; Location of Part.
          • Example:
            • Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia: Lippincott Williams & Wilkins; c2005. Chapter 29, Endometriosis; p. 1103-33.