Punctuation and special characters

In general, do not use an ampersand (&) unless it is part of an official name—for example, Bill & Melinda Gates Foundation—or part of a commonly known abbreviation, such as M&E or R&D. It may be used in tables and figures, however, to save space.

The two major uses of the apostrophe are discussed below.

Possessives

Add an apostrophe + s to form the possessive of singular and plural words and abbreviations that do not end in s:

• We support Zambia’s goal of ending malaria.
• The study analyzed the children’s height and weight.
• The team contributed to WHO's updated guidance.

For singular and plural words and abbreviations ending in s, add an apostrophe but no additional s:

• PVS’ board of directors.
• PAMO Plus’ legacy.
• The virus’ impact.
• The midwives’ feedback.

Contractions

In general, avoid contractions (e.g., we're, don't) in formal writing. Contractions are fine for web copy or when a more casual or familiar tone is desired.

In a title or heading

When a colon is used in a title or heading, what follows is considered a subtitle and therefore should begin with a capital letter (e.g., Usability evaluations: Single-dose packaging and delivery options). The exception is journal article titles that are cited; in this case, where the word following a colon is lowercase unless it is a proper noun (e.g., Cerebral malaria presenting as nonconvulsive status epilepticus: a case report). Within a journal manuscript, however, follow the targeted journal’s guidelines for capitalizing titles.

Before a bulleted list

Add a colon after an introductory phrase or sentence that appears before a bulleted list—for example:

Diagnostics are indispensable for:

• Guiding clinical decisions.
• Averting drug resistance.
• Bolstering disease surveillance.
• Raising early alerts of potential pandemics.

After an independent clause that introduces a list within a sentence

When a list is within the body text (not set off by bullets), use a colon to introduce the list only when the text preceding the list is an independent clause (i.e., can be read as a sentence by itself). Otherwise, omit the colon:

• PATH develops and scales solutions to achieve health equity: vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. [Use a colon because PATH develops and scales solutions to achieve health equity is an independent clause.]
• PATH develops and scales vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. [Do not use a colon because PATH develops and scales is not an independent clause.]

After an independent clause for emphasis within a sentence

When a colon is used after an independent clause to add emphasis to what follows, lowercase the first word after the colon—unless what follows is a full sentence, and then it is acceptable to lowercase or capitalize the first word, but be consistent within the document. Here are correct examples:

• The risk of developing cervical cancer can be greatly reduced with one intervention: the human papillomavirus vaccine. [Lowercase the first word after the colon because it begins a phrase and not an independent clause.]
• Noncommunicable diseases (NCDs) are the leading causes of death and disability globally: two-thirds of deaths worldwide are caused by NCDs, and almost 75 percent occur in lower-resourced settings. [Acceptable to lowercase the first word after the colon (see the following example).]
• Noncommunicable diseases (NCDs) are the leading causes of death and disability globally: Two-thirds of deaths worldwide are caused by NCDs, and almost 75 percent occur in lower-resourced settings. [Also acceptable to capitalize the first word after the colon because it begins an independent clause.]

Use the serial (Oxford) comma after the penultimate item in a list of three or more:

• PATH works with government officials, members of local organizations, and community health workers.

When combining a city, province, or other administrative or geographic unit with that of its larger division, use commas to set off the clarifying elements:

• Many of our Washington, DC, and Nairobi, Kenya, staff are focused on advocacy.

Use an em dash (—) to set off elements in the middle of a sentence (instead of commas) or at the end of a sentence (instead of a colon). Do not insert a space before or after an em dash:

• The clean delivery kit—which helps women and newborns in remote villages avoid life-threatening infections—is a simple approach to reducing infant mortality.
• The key to PATH’s success is our partners—global health agencies, the private sector, national governments, and local communities.

Microsoft Word tip: To insert an em dash in Word, go to the Home tab | Insert | Symbol. The keyboard shortcut is Ctrl + Alt + minus sign on the numeric keypad of a full-size keyboard.

Use an en dash (–) in number and date ranges (e.g., 2–8, 2010–2023) except in narrative text. See also Numbers and measurements / Ranges.

Microsoft Word tip: To insert an en dash in Word, go to the Home tab | Insert | Symbol. The keyboard shortcut is Ctrl + minus sign on the numeric keypad of a full-size keyboard.

Use an en dash in place of a hyphen when one of the elements in a compound adjective is open—for example, health care–related issues. In contrast, care-related issues uses a regular dash (hyphen). If you are uncertain, do not use an en dash. You can also work around it by making a dash of any kind unnecessary (e.g., issues related to health care).

Using a hyphen to connect words can make the meaning clearer. The most important rule of hyphenation is to be consistent within a document (and within related documents, such as a series of articles or books). See also Spelling. Here are a few tips:

• For general guidance—for example, hyphenation of words with prefixes (e.g., co, mid, multi, post, pre, sub)—use Merriam-Webster’s Dictionary and the hyphenation guidelines in The Chicago Manual of Style. If a word listed in the PATH Writing and Style Guide differs from those sources, follow the style guide.
• In general, hyphenate a compound adjective when it directly precedes the noun it is modifying:
  • The study included HIV-positive adults.
• The same compound adjective may not need to be hyphenated when it falls elsewhere in the sentence:
  • The adults in the study were HIV positive.
• When the second part of a hyphenated or closed compound in a series is omitted, use a hyphen after the first part to indicate the relationship. This is called a suspended hyphen. The same idea is expressed in three ways in the following progressive examples. The form with the suspended hyphen is in bold:
  • facility-level staff, district-level staff, and national-level staff > facility-level, district-level, and national-level staff > facility-, district-, and national-level staff
  • pretest results and posttest results > pretest and posttest results > pre- and posttest results
• Use a hyphen when a single word or prefix is joined to a hyphenated compound:
  • in-country-level
  • non-English-speaking
• Do not hyphenate an ly adverb:
  • publicly owned corporation
  • greatly desired outcome
  • Note that early-stage clinical trials is hyphenated because early is being used as an adjective not an adverb
• When in doubt, keep your audience in mind and strive for clarity.

When using quotation marks, American-style punctuation calls for commas and periods (full stops) to be placed within the quoted material. All other punctuation should be placed outside the quoted material unless it is part of the quoted material:

• “The pandemic has shifted multiple paradigms for vaccine development,” said Dr. Bhat. “We must ensure that rapid inclusion of pregnant people is one of them.”
• The moderator asked the panelists, "What can we do to improve the supply chain?”
• Did you read the article where Dr. Mahmood noted that “global demand for IPV is growing”?

PATH style prefers the use of italics to denote words referred to as words (see also Formatting PATH documents / Italics). However, in situations where quotation marks are used for this purpose, commas and periods (full stops) are set within the quotation marks. All other punctuation is set outside the quotation marks:

• The Uniject™ injection system is described as "autodisable," "prefilled," and "single-dose."
• The Uniject™ injection system is described as “autodisable”; the SoloShot™ syringe is also in this category.

For use of quotation marks in British English, see British style / Quotation marks.

To avoid confusion, it is highly recommended (but not required) to use semicolons between items in a list of three or more when one or more contains an internal comma(s):

• The onset of the COVID-19 pandemic introduced a new set of challenges: essential health services were interrupted; some health workers, equipment, and supplies were redistributed; people were reluctant to seek care because of fear of infection; and school closures contributed to a rise in gender-based violence and teenage pregnancies.

For a list that includes organization names that have commas, consider your intended audience when selecting a style. Either of the following are acceptable:

• PATH partnered with UNICEF; Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Health Organization.
• PATH partnered with UNICEF, Gavi, the Vaccine Alliance, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization.

See also Partner and funder names / When there are commas in the name.

Commas are always acceptable when only the last item contains an internal comma(s):

• PATH’s work includes advocacy to improve public health policies, digital solutions to strengthen health systems, and targeted interventions to improve the health of women, children, and other populations.