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Technical Guidelines for United States—Mexico Coordination

on Public Health Events of Mutual Interest

1. Introduction

In 2002, within the framework of the United States—Mexico Binational Commission, 

representatives from the U.S. Department of Health and Human Services and Mexico’s 

Secretaria de Salud established a binational group on Epidemiologic Surveillance and 

Information Exchange to address issues of interest to both countries. With the objective 

of better defining how the two countries should collaborate on epidemiologic events of 

mutual interest, the present document has been elaborated by federal and state public 

health officials from both countries to provide a set of shared guidelines. 

The United States and Mexico have a rich tradition of collaboration on epidemiologic 

events involving the two countries, including infectious disease outbreaks, diseases 

associated with products from the other country, and the continuity of care for patients 

with tuberculosis and other key diseases, traveling between the two countries. A joint 

Border Infectious Disease Surveillance project has been in place since 1999, and an Early 

Warning Infectious Disease Program was initiated in 2004. In addition, the TB Crossborder Management and Referral Project facilitates healthcare provider access to 

information on TB patients traveling between the two countries to ensure continuity of 

therapy. The Laboratory Response Network, providing diagnostic support for select 

pathogens, includes public health laboratories from both Mexico and the United States as 

members. Facilitated by the close ties resulting from these and other collaborations, 

public health professionals from the two countries have regularly sought to keep their 

counterparts apprised of relevant epidemiologic events. 

However, clear guidelines have not yet been formally adopted for what information 

should be shared and how the sharing should take place. Public health officials from the 

two countries chose to formulate such a set of guidelines with the objectives of better 

institutionalizing the exchange of information on epidemiologic events of mutual interest, 

and promoting collaborative responses when appropriate. 

Recognizing that productive collaboration already occurs between many ‘sister cities’

along the United States—Mexico border and between neighboring states, it should be 

emphasized that the present Technical Guidelines for United States—Mexico 

Coordination on Public Health Events of Mutual Interest (Guidelines) should facilitate 

the continuation of existing binational cooperation, while at the same time fostering more 

systematic and comprehensive sharing of information at all levels of government. These 

Guidelines focus primarily on coordination between the public health agencies/units that 

have primary responsibility for epidemiologic surveillance. They do not seek to define 

coordination between agencies/units with major regulatory functions, for which 

arrangements have already been established. 

These Guidelines are being formally adopted following the entry into force in 2007 of the 

International Health Regulations (IHR). The IHR 

(http://www.who.int/ihr/9789241596664/en/index.html) provide a legally binding global 
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framework for the detection of, and response to, Public Health Emergencies of 

International Concern (PHEIC) requiring member nations to notify the World Health 

Organization (WHO) of any potential PHEIC. 

Given the very specific definition of what represents a PHEIC, the present Guidelines 

cover a broader scope of Public Health events than the IHR, addressing all Public Health

events of interest to both the United States and Mexico, not being limited to public health 

emergencies. In addition they are based on bilateral coordination to address the Public 

Health event of interest, without a requirement to involve WHO or the Pan-American 

Health Organization. However, for any such event involving the two countries and that 

constitutes a PHEIC, the terms of the IHR prevail. In addition, Public Health events 

qualifying as a PHEIC such as the 2009-10 influenza pH1N1 pandemic illustrate how 

binational cooperation prior to and during the PHEIC can contribute to global response. 

The Guidelines are further consistent with and supportive of the IHR by representing a 

response to several of its articles regarding interactions between nations. 

 Article 21 – Ground Crossings – “States Parties sharing common borders should 

consider entering into bilateral or multilateral agreements or arrangements 

concerning prevention or control of international transmission of disease at 

ground crossings in accordance with Article 57”

 Article 44 – Collaboration and Assistance – which encourages State Parties to 

collaborate on “the detection and assessment of, and response to, events”, “the 

provision or facilitation of technical cooperation and logistical support, 

particularly in the development, strengthening and maintenance of the public 

health capacities”, “the mobilization of financial resources to facilitate 

implementation of their obligations” and “the formulation of proposed laws and 

other legal and administrative provisions for the implementation of these 

Regulations”

 Article 57 – Relationship with other International Agreements – which asserts that 

States Parties “having certain interests in common owing to their health, 

geographical, social or economic conditions,” may develop “special treaties or 

arrangements in order to facilitate the application of IHR,” in particular “the 

direct and rapid exchange of public health information between neighboring 

territories of different States”, and the application of health measures at common 

frontiers.

These Guidelines regard binational public health events as those affecting individuals or 

populations who translocate between the two countries. This concept recognizes that the

rich and complex migration dynamics between the two countries extends beyond the

United States-Mexico border area – currently considered 100 km (62 miles) at each side 

of the borderline, into the territories of Mexico and the U.S – and determines the risk of 

propagation of infectious diseases and other public health threats.

This document has adopted the term binational case for referring to a confirmed or 

probable case of disease or other health event in an individual:

 who has recently traveled or lived in the neighboring country, or had recent 

contact with persons who lived or traveled in the neighboring country; or 
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 who is thought to have acquired the disease in the neighboring country or 

have been in the neighboring country during the incubation period of an

infection and was possibly contagious during this period; or

 who is thought to have acquired the disease from a product or other exposure 

in the other country; or

 whose case requires the collaboration of both countries for the purposes of 

disease investigation and control, regardless of the presumed site of infection 

or exposure

These Guidelines are meant to provide guidance for public health agencies or institutions 

and their staff in responding to public health events of shared interest to both countries. 

While the Guidelines are not binding, it is planned they will lead to the development of 

shared protocols to facilitate their full implementation. 

2. General Principles

The guidelines of this document are based on the following principles:

2.1. The Need to Share Information

The primary mission of public health agencies or institutions of the United States and 

Mexico is to protect and promote the health of their citizens. Public health events 

involving both countries – by geographic proximity, by translocation of their citizens, by 

exchange of their products, or by concurrent presentation of events – require the sharing 

of information between counterpart institutions. Such sharing has the objectives of 

providing information about potential risks and facilitating an appropriate response for 

the protection of the health of the public, in whichever country they reside. Adequate 

preparation for the risks of bioterrorism or other public health emergencies further 

requires that well-functioning, clearly defined channels of communication be established

prior to the occurrence of such an event, to facilitate effective sharing of crucial 

information, and articulation of coordinated responses to ensure the greatest protection 

possible of the public’s health. 

In addition to sharing information to directly protect the public’s health, counterpart 

agencies are also expected to share information on other public health matters affecting 

both countries, such as revised policies, advisories or alerts on travel or imported 

products from the other country. Such alterations in one country’s positions create 

important demands on the public health agency of the other country, for which they 

should be as well prepared as possible to respond. 

2.2. Timely Sharing of Information

The value of epidemiologic information is closely linked to its timeliness. When needed, 

the sharing of such information between the United States and Mexico should occur in a 

time frame which allows the other country to respond to the specific health need in as 

timely a manner as possible, maximizing the potential for effective public health action to 

prevent avoidable disease, disability and mortality. As such, information shared may be 

preliminary in nature and subject to change as events evolve. Preliminary information 

should be clearly communicated as such.
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2.3. Quality of Information 

The value of the epidemiologic information being shared depends on its accuracy and 

completeness. The national and state public health authorities of both countries need to 

commit to providing the most comprehensive and current epidemiologic information 

available.

2.4. Communication Pathways 

Clearly defined pathways between public health agencies or institutions of the United 

States and Mexico for communication of such epidemiologic information should be 

established to ensure rapid delivery to the appropriate agency and a high potential for 

action based on the information.

Information exchange between the two countries should be reciprocal and favor 

symmetry in the participation of different levels of government of the two countries. 

When a specific need for binational information exchange arises, public health agencies 

at the local, state or federal levels of one country should communicate with their 

counterpart agency of the same level in the other country (i.e., local–local, state–state, or 

federal–federal). This should be conducted in parallel with communication to federal 

partners, as defined by national policies. Federal public health agencies or institutions or 

officials who intervene, participate, facilitate, or promote binational exchange of 

information between state or local public health agencies, regarding a particular public 

health event, should communicate with their federal counterparts in the neighboring 

country before directly interacting with state and local levels of that country.

While communications transmitted in the language of the other country are encouraged,

communications in the language of the provider country are acceptable means of 

information exchange for the purposes contemplated in these Guidelines.

2.5. Confidentiality, protection of privacy, and dissemination of information

Epidemiological information may be sensitive in nature. Inappropriately handled 

information may expose individuals, communities and countries to stigma or discredit, 

affecting their stability, security and wellbeing. Therefore, both countries should protect 

the information shared by the neighboring country and establish secure mechanisms and 

tools for transmitting and storing all information shared by the other country. 

Information exchange discussed in this document aims to facilitate effective and timely 

public health action. This information should not be disseminated outside the purview of 

relevant public health authorities unless by mutual agreement or if it has been made 

public by the provider country. If public health agencies or institutions of the country 

receiving the information are obligated to share data beyond its original purpose because 

of legal requirements – such as judicial order or freedom of information acts – or they 

become aware of an unintentional leak of information, they should warn as soon as 

possible the relevant public health agencies of the provider country. 

2.6. Joint Action to Respond to an Public Health Event 

When an epidemiologic event occurs involving both countries and both have an interest 

in investigating the event (such as an outbreak investigation), the two countries should 
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make a determined effort to conduct the investigation together. In this situation, the 

national public health agency of the country in which the study will take place should

assume the coordinating role in accordance with its jurisdiction. At all times, the 

receiving country has the prerogative of cancelling an invitation or finalizing the joint 

investigation of a particular public health event. In Mexico inviting or declining the 

collaboration of another country’s health officials is an attribution reserved to the federal 

government, whether or not federal health agencies or personnel participate in 

epidemiological investigations or disease control measures of a particular public health 

event. 

Each country should be expected to provide the technical and financial support needed 

for its participation, recognizing that this will be subject to the availability of funds and 

the applicable provisions of the respective country. Sharing of resources, e.g. laboratory 

testing, may be necessary, is highly encouraged, and should be negotiated in a timely 

fashion. The timeliness of the investigation should be accorded a high priority by both 

countries. When rapid action is appropriate, the deployment of a team of the country 

where the outbreak is occurring should not be slowed by the delayed mobilization of the 

corresponding team from the other country; that is, the response to the event by the 

affected country should not be delayed pending arrival of the team of the other country. 

2.7. Differences between Health Systems 

The roles of public health agencies or institutions of the United States and Mexico at the 

different levels of government are not always the same. In the United States, the public 

health sector is primarily state-based. In Mexico, although states are legally competent 

for performing some public health activities, these are subject to the overall direction of 

the Secretaria de Salud of the Federal Government. Such differences should be taken 

into consideration in mounting the necessary responses when the two countries face an 

epidemiologic event requiring collaboration. 

2.8. Respect for the Sovereignty and Laws of Each Country

The responsibility for all public health responses to binational events lies with the public 

health agencies or institutions of the country where the respective activities will take 

place. All parties recognize the need for these same public health agencies or institutions 

to operate within the legal framework established by that country. If legal or other 

barriers are identified which limit the capacity of public health agencies or institutions to 

collaborate with counterpart agencies of the other country in the most effective way, the 

public health agencies should investigate possible solutions to such barriers. 

3. Legal Framework 

The following section reviews the legal framework currently in place for implementing 

these Guidelines, from the perspective of the U.S. federal and state governments and the 

Government of Mexico. 

Federal and State Governments of the United States

The Public Health Service Act (42 USC § 241 et seq.) provides the Department of Health 

and Human Services (HHS) with a broad authority to conduct activities relating to the 
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prevention and control of diseases and injuries. It also authorizes HHS to participate with 

other countries in cooperative endeavors to advance health sciences and improve the 

health of Americans (42 U.S.C. § 242l). Requirements for disease reporting are typically 

defined in laws at the state and local level. The Centers for Disease Control and 

Prevention (CDC), however, together with the Council of State and Territorial 

Epidemiologists (CSTE) have defined a list of nationally notifiable diseases and 

conditions, and states provide information about these to CDC’s National Notifiable 

Diseases Surveillance System and other CDC surveillance systems. In addition, ships 

and airlines are required by federal regulation to report deaths or ill passengers to CDC 

quarantine stations. CDC also operates various surveillance systems that track particular 

disease problems of national interest. 

The Privacy Act of 1974 (5 USC § 552a) establishes a code of fair information practices 

that governs the collection, maintenance, use, and dissemination of information about 

individuals that is maintained in systems of records by federal agencies. A system of 

records is a group of records under the control of an agency from which information is 

retrieved by the name of the individual or by some identifier assigned to the individual.

The Privacy Act requires that agencies give the public notice of their systems of records 

by publication in the Federal Register. The Privacy Act prohibits the disclosure of a 

record about an individual from a system of records absent the written consent of the 

individual, unless the disclosure is pursuant to one of twelve statutory exceptions. The 

Act also provides individuals with a means by which to seek access to and amendment of 

their records, and sets forth various agency record-keeping requirements. While the Act 

sets controls on the terms by which federal agencies can gather, maintain, and 

disseminate personal information, it also defines circumstances in which disclosure of 

information is permissible without the subject’s consent. This includes disclosure “to a 

person pursuant to a showing of compelling circumstances affecting the health or safety 

of an individual” if notice of the disclosure is transmitted to the individual’s last known 

address and pursuant to a routine use as defined in the system of records published by the 

agency. The system of records applicable to most of CDC’s surveillance projects, 

“Epidemiologic Studies and Surveillance of Disease Problems” authorizes, among other 

things, disclosure to “cooperating medical authorities.” 

The Freedom of Information Act (FOIA, 5 USC § 552) provides that any person has a 

right to obtain access to federal agency records, except to the extent that such records (or 

portions of them) are protected from public disclosure by one of nine exemptions or by 

one of three special law enforcement record exclusions. It applies only to federal records, 

though U.S. states have their own equivalent statutes. The FOIA provides access to all 

federal agency records except for those records (or portions of records) that are protected 

from disclosure. 

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) 

Privacy Rule regulates how “covered entities” – e.g. healthcare providers, health plans, 

health billing services – use and disclose certain individually identifiable health 

information known as “protected health information” (PHI). While CDC is not 

considered a “covered entity,” some state and local health departments may be. The 

HIPAA Privacy Rule recognizes the legitimate need for public health authorities and 

others responsible for ensuring public health and safety to have access to PHI to carry out 
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their public health mission. The Privacy Rule permits covered entities to disclose PHI, 

without authorization from the subject, to public health authorities (e.g., CDC, State and 

local health departments) that are legally authorized to receive such reports for purposes 

of preventing or controlling disease, injury, or disability. This includes, for example, 

reporting of disease or injury; reporting vital events, such as births or deaths; and 

conducting public health surveillance, investigations, or interventions. At the direction of 

a public health authority, covered entities may disclose PHI to a foreign government 

agency that is acting in collaboration with a public health authority (45 CFR 

164.512(b)(1)(i)). Covered entities may only disclose the minimum PHI necessary to 

accomplish the permitted purpose (45 CFR 164.502(b)(1)). However, the covered entity 

may reasonably rely on the representation of a public official requesting the information 

that it constitutes the minimum necessary (45 CFR 164.514(d)(3)(iii)(A)).

Under the U.S. federal system, each state enacts health and safety laws within their 

jurisdictions. Each state must review its laws relating to these Guidelines to determine 

whether legal authority exists to exchange public health information and to collaborate in 

other ways with counterparts in Mexico on public health issues of mutual interest. Some

states have examined their legislation, seeking to identify potential barriers to the sharing 

of epidemiologic information with Mexico.1,2 All states are encouraged to complete an 

analysis of their laws for this purpose. In those cases where barriers are identified, states 

are encouraged to consider new legislation that would provide such authority, based on 

the value of such collaboration for the improvement of public health in our countries. 

Mexico’s local, state and federal health agencies reserve the right to limit sharing of 

information with those states whose legal barriers limit the exchange of epidemiologic 

information with Mexico.

In summary, U.S. federal legislation permits the sharing of epidemiologic information by 

federal agencies with a foreign country for the prevention or control of disease, with 

necessary restrictions based on confidentiality. Each state needs to review its own 

legislation to determine whether barriers exist to the exchange of such information. If 

present, this legislation should be reconsidered to ensure that state public health officials 

have the needed authority to improve the public’s health through the sharing of such 

information. With the requisite authority under state law, states would be constitutionally 

permitted to enter into cooperative arrangements with each other and with Mexican states 

for the purpose of sharing epidemiologic information.

Federal Government of Mexico

The legal framework of Mexico for epidemiologic surveillance and health information is 

composed of a set of legal arrangements that include the Mexican Constitution, laws, 

regulations, decrees, secretarial agreements, norms, agreements and guidelines of the 

National Epidemiologic Surveillance Technical Sectorial Committee Specialized in 

Health (Annex 1). Among the most prominent are the following.

 

1 Barriers to Binational Cooperation in Public Health between Texas and Mexico, Office of Border Health, 

Texas Department of Health, 2001 

2 Annual Border Health Status Report, 2001: Barriers to California-Mexico Collaboration in Public Health, 

California Office of Binational Border Health, California Department of Health Services
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The Political Constitution of the United Mexican States, in its Article 4, Paragraph 4, 

establishes the right of health protection . Article 73, Section XVI, first basis, establishes 

the General Public Health Council (GPHC), a body of the Mexican State directly 

dependent of the President of the Republic, chaired by the Secretary of Health. The 

GPHC has authority to issue mandatory provisions in public health. The Council is the 

second health authority in the country, preceded only by the President of the Republic.

The General Health Law (GHL) describes the terms for the application of the universal 

right to health protection established in Article 4 of the Constitution. This law is 

mandatory for all public and private entities and individuals in Mexico. The GHL defines 

General Public Health and determines the respective competencies and collaboration of 

the Federal and State governments in the matter.

The Federal Law of Transparence and Access to Public Governmental Information 

(FLTAPGI) establishes the rules and mechanisms to assure persons have access to 

information stored by the Federal Government or autonomous institutions, except for 

information that is classified as reserved. All 32 states in Mexico have similar bylaws.

The reform of FLTAPGI, published in the Official Journal of the Federation on July 5, 

2010, defines the mode in which personal data will be handled and establishes principles 

and procedures to store, transmit, and limit access to data containing private or

confidential information of persons. Although this law generally inhibits transmission of 

nominal data, it contemplates the use of such information for specific technical purposes 

of governmental agencies, provided the appropriate mechanisms are observed to avoid 

unintentional transmission of information beyond the intended agencies and purposes.

The Mexican Official Norms for Epidemiologic Surveillance (NOM 017-SSA2-1994) 

and Health Information (NOM 040-SSA2-2004) determine institutional responsibilities 

and procedures to conduct surveillance, including notification, data integration and 

communication. 

The Mexican constitution in Article 117, Fraction I, states that “the States cannot, under 

any circumstance, sign agreement, treaty or coalition with another State or foreign 

power...” [but, similarly to the United States, they may be able to sign non-binding 

agreements].

In summary, no part of relevant Mexican laws contemplates sharing public health 

information with other countries but also does not forbid sharing of such information 

internationally. Mexican law determines disease prevention and control in Mexico to be

an exclusive attribution of Mexican health authorities, but allows the Federal Government 

to establish specific collaboration agreements with other parties, including international 

agencies and other governments. 
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Other United States–Mexico Collaborations

These Guidelines are also consistent with other terms agreed to between public health 

authorities of the two countries. In March 2008, HHS and SSA established a 

Memorandum of Understanding on Cooperation in the Fields of Public Health and 

Science, providing a “framework to encourage bilateral cooperation” in which efforts are 

meant to “foster collaboration where areas of mutual interest exist.” Among the areas 

cited for cooperation is “the detection, surveillance, and reporting of infectious and 

chronic diseases, to enable better tracking and analyses of prevalence and trends, so as to 

improve the prevention and care of, and the response to these diseases.” In 2007, a 

mutual assistance agreement also was adopted by the United States, Mexico and Canada 

for addressing public health emergencies, referring to the sharing of information, and 

implementation of protocols for laboratory collaborations, among other areas.

Other existing mechanisms for collaboration between governments of the two countries 

on public health issues include the United States – Mexico Border Health Commission, 

the United States–Mexico Food Safety Cooperative Agreement, the Border Governor’s 

Conference, the Pan American Health Organization (PAHO) El Paso Field Office, border 

state Memoranda of Understanding, and Binational Health Councils of border Sister 

Cities. Joint public health collaborations are in place between the two countries in the 

areas of tuberculosis (Ten Against TB, Binational TB Card), infectious disease 

surveillance (Border Infectious Disease Surveillance – BIDS, Early Warning Infectious 

Disease Surveillance – EWIDS), influenza and others. 

In conclusion, the legal frameworks of the two countries at the national level allow for 

the exchange of information, as proposed in these Guidelines. States or federal entities 

that are part of each of the countries will need to analyze their own local legal framework 

in order to verify that its arrangements are aligned with and complement the Guidelines 

provided here. Numerous interfaces are already in place between health authorities of the 

United States and Mexico, reflecting the need and desire to assist each other in 

confronting shared public health challenges. 

4. Scope of Public Health Events

The purpose of this chapter is to characterize the scope or range of public health events 

for which both countries determine that exchange of epidemiologic information is 

appropriate. It is understood that the information to be shared by one country has the 

objective of leading to or facilitating action in the second country which will be of direct 

benefit to the health of the population of one or both countries. This would include: 

A. Cases of disease identified in one country for which there is evidence or reason to 

suspect an epidemiologic link to the other country, including diseases detected in 

animals, or that such a link may occur in the future due to expected travel to the 

neighboring country; 

B. Similarly, the identification of risk factors for disease in one country that may 

lead to disease in the other country. When a country identifies risk factors for 
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disease in a location outside its territory that may affect the neighboring country, 

efforts should be done to timely share relevant information with the potentially 

affected country. 

Types of public health events that meet these criteria include, but are not limited to:

 A probable or confirmed case of any severe or otherwise important infectious 

disease with high potential for spread to the other country

 Infections in animals or vectors with potential for spread of severe or 

potentially severe disease to humans

 A probable or confirmed case of severe or potentially severe disease suspected 

of having been intentionally spread

 Disease outbreaks involving both countries at the time of discovery or which 

have a significant potential for spread to the other country 

 Outbreaks of disease associated with travel or migration to the other country

 Outbreaks of disease or chemical contamination associated with food or other 

products originating in the other country

 Environmental health emergencies potentially or actually affecting both 

countries

 Binational cases of pre-established/or agreed notifiable diseases

There is a tremendous interaction between the United States and Mexico, reflected by 

almost 128 million visitors from Mexico to the United States and almost 95 million US 

visitors to Mexico in 2005.3 While border region traffic makes up the majority of such 

travel, travel occurs between all regions of Mexico and the United States. For example, 

over 65% of US air travelers to Mexico in 2010 flew to Mexico City, Cancun and 

Guadalajara. Therefore, the potential of a public health event to be binational should be 

considered throughout the full reach of both countries.

5. Specific Guidelines 

This section presents specific guidelines for different types of events and for different 

areas of collaboration. 

5.1. Binational Public Health Events

Binational public health events are those potentially or actually affecting individuals or 

populations in both countries. Binational events encompass cases, outbreaks, threats and 

risks, exposures and, generally, all relevant public health situations of concern to both 

countries.

Binational Cases

As stated earlier, a binational case refers to an individual who is a confirmed or probable 

case of an infectious disease or ailment, notifiable in either country, who may have 

 

3 North American Transportation Statistics, http://nats.sct.gob.mx/nats/sys/tables
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acquired or may transmit the disease in the other country, or who may require binational 

collaboration for investigation, management or control.

An example of a binational case is a person with tuberculosis (TB) under treatment who 

crosses the border during the course of his or her medical care and public health followup. Such a binational TB case is thus at risk for interruptions in treatment with the 

consequent possibility of transmitting TB to others, as well as of developing drug 

resistant tuberculosis. Based on the “Need to Share Information” (General Principle 2.1 

of these guidelines) identification of binational cases by public health authorities warrants 

the sharing of relevant information with counterparts of the neighboring country to assist 

in finding exposed individuals and other cases, to limit the risks of further disease 

transmission, and to ensure adequate control of the disease among identified cases.

1. Identification of Binational Cases – The determination of whether or not a 

person with a notifiable disease is a binational case requires obtaining information 

that currently is not routinely gathered. States should encourage health 

professionals making disease notifications of the need to explore whether cases 

are binational, especially in settings where this is more likely to occur (locations 

with considerable travel between the countries, migrant populations, etc.). In the 

future, public health authorities should consider the value of incorporating 

information specifically designed to identify binational cases along with the other 

information to be routinely reported. A list of potential diseases defining 

binational cases and questions designed to elicit such information should be 

prepared as part of the implementation phase of these Guidelines, being careful 

not to exclude unknown or unspecific events that are binational by nature (eg. 

environmental exposures, infectious disease pandemics, etc.). 

2. Notification of Binational Cases – Recognizing that binational cases, by 

definition, imply a public health risk to the neighboring country and usually 

require prompt public health action, binational cases of notifiable infectious 

diseases should be promptly reported to the appropriate public health official(s) in 

the neighboring country. Public health authorities of both countries should

become familiar with the list of conditions that are notifiable in each country. The 

questions contained in the decision tool of the IHR Annex 2 may help to assess 

whether a particular condition in an individual should be regarded as a binational 

case, as well as whether it is considered notifiable under the IHR.

3. Information on Binational Cases – When necessary, the information shared on 

binational cases should be sufficient to allow appropriate public health follow-up 

of the case to take place. In some circumstances, this may entail sharing patient 

identifying information. Following the public health laws and privacy regulations 

of both countries, information exchange needs to be handled confidentially.

Health officials receiving identifying information should use it responsibly for the 

sole purpose of instrumenting public health action. 

4. Timely Reporting of Binational Cases – Time frames should be established by 

both countries for reporting binational case to public health authorities. Urgently 
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notifiable conditions, as defined by the relevant agencies, should be reported 

within 24 hours following a first identification. 

5. Procedures for Notification of Binational Cases – Clear mechanisms of 

notification should be established by public health officials of both countries, at 

the different levels of government, which specify:

 Counterpart agency and corresponding office to notify

 Channels, tools and formats of for communication that minimize delay in 

receiving the notification and assure safe and confidential transactions 

(e.g. telephone, fax, email, electronic file, secure web-based systems, etc.)

 Information to be included regarding the binational case(s)

6. Follow-up Information on Binational Cases – The two countries should 

exchange follow-up information on binational cases so that the effectiveness of 

binational case notification and coordinated case management and investigations 

can be determined. Public health officials of both countries should agree on 

protocols for case follow-up. 

Binational Outbreaks 

The term outbreak refers to an increase in the expected number of cases of a specific 

disease or other health problem in a given population over a defined time period. The 

number of cases required to consider a cluster of disease cases an outbreak thus obviously 

depends on historical epidemiologic data and diagnostic criteria and laboratory resources. 

A single case of a rare disease, such as cholera, or an eradicated disease such as 

smallpox, may constitute an outbreak, while numerous cases of more common diseases 

such as HIV/AIDS or tuberculosis may be required to be considered an outbreak. Newer 

diagnostic capabilities, such as molecular fingerprinting techniques, can identify a cluster 

of illnesses with indistinguishable molecular characteristics; epidemiological 

investigation is then used to find links between these cases in the cluster. This 

combination of molecular characterization of microbes and epidemiological investigation 

has identified numerous outbreaks, including widely dispersed outbreaks that would 

otherwise have gone undetected. An outbreak is considered binational:

 when disease exposures occur in one country to visitors or migrants of the other 

country, 

 when disease is associated with products from the other country

 when environmental/ecologic exposures causing disease simultaneously affect 

both countries, or 

 when cases appear in border settings involving the population from both 

countries. 

Upon recognition of a binational outbreak, if new cases continue to appear or exposure to 

causal agents persists, a rapid response should be organized to accurately diagnose the 

illness, to determine the scale of the outbreak, to identify significant risk factors, or to 

implement appropriate preventive and control measures. Coordination between public 

health agencies or institutions of the two countries is essential for meeting the needs of all 

relevant parties and to achieve the most effective use of available resources.
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1. Preparing for Binational Outbreaks – Pre-event preparations that should be 

implemented include: 

 Exchange updated lists of binational contact information at the local, state, 

and federal levels, including information that provide for round-the-clock 

availability

 Establish mechanisms for communication in both Spanish and English

 Define and practice communication protocols for notification to public health 

officials

 Plan for needed responses for diverse kinds of public health threats 

 Establish mechanisms for the transportation of specimens or needed supplies 

through U.S. and Mexican customs

2. Communications among Health Authorities during Binational Outbreaks 

Once a binational outbreak is identified, the appropriate public health officials 

should be notified, following a pre-defined communications protocol. The public 

health authorities from each country should share the available data, and take a 

decision on the most appropriate response, including a decision whether or not to 

initiate a binational investigation. 

3. Collaborative Investigations of Binational Outbreaks – Upon binational 

concurrence to conduct a binational investigation or response effort, a binational 

oversight team of public health officials from the two countries should meet. 

Unless defined otherwise, the coordination of the investigation will be the 

responsibility of the lead public health authority where the outbreak is to be 

investigated. Agreement of the Mexican Federal Public Health authorities is 

always required when a binational team is expected to work in Mexican territory. 

The oversight team should be responsible for or coordinate: 

 choosing the members of the binational field investigation team, including a 

team leader from each country 

 field work preparation, including arrangements for any necessary travel, 

personal protective gear, prophylaxis, and availability of supplies and 

equipment

 planning and implementation of the investigation 

 content of health alerts and press releases

 determination of control measures based on information provided by field 

staff

 administrative arrangements and logistics to support the binational team 

4. Resources for Collaborative Investigations – Each country is responsible for 

funding the travel of participants of that country in the investigating team. 

Primary resources needed for the investigation itself should be the responsibility 

of the lead public health agency where the investigation takes place. In the 

absence of needed supplies or investigative capacity (e.g. select laboratory 

exams), sharing of technical resources between counterpart agencies is strongly 

encouraged. 
14

5. Binational Cooperation in Sharing Public Health Resources – National and 

state public health agencies or institutions are encouraged to share informational 

and other resources designed to strengthen the epidemiology and response 

capacity of binational counterparts. Joint participation by multinational agencies 

(e.g. PAHO/WHO) and NGOs (e.g. TEPHINET) may provide additional 

opportunities to identify such needs and appropriately collaborate with the U.S.

and Mexican Public Health authorities. 

5.2. Foodborne Disease Outbreaks

Contaminated foods are responsible for many infections and toxic exposures. Within the 

United States, foodborne diseases are estimated to be responsible annually for 48 million 

illnesses and 3,000 deaths. The growing international trade of agricultural products has 

correspondingly been associated with outbreaks due to pathogens transmitted by foods 

imported from another country. The United States and Mexico have collaborated in 

responding to several such outbreaks. 

The organization of governmental roles in food safety often includes multiple agencies in 

both the health and agricultural sectors, and at the federal, state and local levels. To 

facilitate needed collaboration, a clear definition of the different roles of such agencies 

must be understood by neighboring countries, including the responsibility of each in 

responding to outbreaks of foodborne diseases. 

At the national level within the United States, the CDC is responsible for surveillance of 

human illness caused by foodborne disease and for epidemiological and laboratory 

investigation of outbreaks of foodborne illness. The United States Department of 

Agriculture (USDA) is responsible for regulating meat, poultry, and processed egg

products. The Food and Drug Administration (FDA) is responsible for regulating all 

other foods, which includes seafood, dairy products, fruits, vegetables, and shell eggs, 

among other products.

At the state level in the United States, the foodborne illness surveillance and investigation 

responsibility rests with the health agency at the state and local level, while the regulatory 

responsibility may rest with the agriculture department or the health department at the 

state level or the local health agency at the local level. When states want assistance from 

the CDC for foodborne outbreak investigations, state officials must make a formal 

request to CDC because CDC does not send investigators without an invitation from state 

officials. In the event of an inter-state or international foodborne outbreak, the FDA 

and/or USDA would be contacted in order to cooperate with multiple jurisdictions in 

coordinating the outbreak investigation, including traceback, trace-forward and potential 

product recall.

At the local government level in the United States, there is wide variation in food safety 

roles and responsibilities among the 3000 local health agencies. In many localities, 

sanitarians have the primary responsibility for investigating reports of foodborne illness 

related to food service establishments, whereas in other localities reports of foodborne 

illness are investigated by state officials and the local sanitarians serve in a secondary 

support role. 
15

Within Mexico, the National Service for Agro-alimentary Health, Safety and Quality 

(SENASICA) is a decentralized organ of the Ministry of Agriculture, Livestock, Rural 

Development, Fisheries and Food (Secretaria de Agricultura, Ganadería, Desarrollo 

Rural, Pesca y Alimentación). The Federal Commission for Protection against Sanitary 

Risks (COFEPRIS) is the decentralized organ of the Secretaria de Salud, with 

jurisdiction over control and public health surveillance of food and drinks, pesticides, 

plant nutrients, toxic or otherwise dangerous substances, biotechnology products, food 

supplements, raw materials and additives used in manufacturing of these products, among 

others. . When informed by any domestic or international party of a foodborne disease 

outbreak associated with a product from Mexico or other country, COFEPRIS 

coordinates internally and externally with other government agencies, according to the 

nature of the event. 

The complexity of institutional organization on food safety in both countries creates an 

important need for collaboration between federal, state, and local authorities across 

international borders.

Foodborne disease outbreaks often imply the need for two or more stages of

investigation. The first stage is the primary epidemiologic and environmental

investigation which aims to identify the agent, the food vehicle and how the food became 

contaminated. Traceback of the food vehicle will indicate whether it is a domestic or 

imported product. In the latter case, and if the food product is suspected to have been 

contaminated at its point of origin, further traceback investigation of the implicated food 

product should determine its source. Additional investigation may identify how the food 

product became contaminated, where the most effective opportunity for future prevention 

exists and the need for regulatory action. These investigations represent important 

opportunities for collaboration between the two countries. 

1. Regulatory Responsibilities in Foodborne Disease Outbreaks – Given that 

public health actions related to products fall under the legal responsibility of 

regulatory agencies, sharing of information should be conducted in accordance 

with the policies of those agencies and within the framework of the existing 

arrangements between the food regulatory agencies in Mexico and the United 

States. 

2. Trade-related Implications – Recognizing that foodborne outbreaks can have 

significant effects on trade, each country should conduct investigations and other 

activities in compliance with any applicable trade obligations. Epidemiologic 

conclusions should be based on highly reliable scientific methods providing 

results which are shared with counterpart agencies in the other country.

3. Advanced Diagnostic Technologies – The use of advanced technologies (e.g. 

pulsed field gel electrophoresis) for subtyping of human and food isolates should

be encouraged, as well as the sharing of findings from such technologies with 

counterparts in the two countries. 

4. Confidentiality and Information Sharing – Public health agencies or 

institutions and food safety regulatory agencies in both countries are obliged to 
16

maintain the confidentiality of patient identification and trade secret information

in accordance with their respective laws, practices and policies. Quick sharing of 

specific information among relevant agencies in both countries on the number and 

locations of persons who have become ill, the associated epidemiologic 

information implicating food vehicles, as well as the point of origin and total 

distribution of the implicated foods, is important to the rapid, appropriate and 

effective response to a binational outbreak of foodborne disease. The parameters 

that define which data should be shared and the conditions under which data 

sharing can legally occur should be determined in advance for binational food 

safety emergencies.

5.3 Potential Terrorist Events of Public Health Importance

The possibility of introduction of biologic, chemical, radiological, or nuclear agents by 

way of the United States-Mexico border or the intentional release of an agent in one 

country with transmission to the other makes this an issue of interest to both countries. 

Such a scenario could include the appearance of cases in the border region which would 

require close binational coordination. 

The suspicion or identification of such an event as being intentional would lead to the 

application of legal arrangements other than those addressed in these Guidelines and 

potential participation of other agencies outside the health sector, with which national 

public health agencies or institutions would need to cooperate, as defined in their 

respective national emergency response plans. 

Since disease arising by intentional spread may well appear without previous notice, 

health officials should be aware of suggestive features of such an incident, including the 

following: 

 An outbreak of an unusual syndrome or disease, compatible with agents 

associated with bioterrorism, especially when occurring in a discrete population.

 Many cases of unexplained diseases or deaths

 More severe disease than is usually expected for a specific pathogen or failure to 

respond to standard therapy

 A disease that is unusual for a given geographic area or transmission season.

 Multiple simultaneous or serial epidemics of different diseases in the same 

population

 Unusual strains or variants of organisms or antimicrobial resistance patterns 

different from those circulating

 Similar genetic typing of agents isolated from distinct sources at different times or 

locations

 Intelligence of a potential attack, claims by a terrorist or aggressor of a release, 

and other evidence suggesting terrorist intent

 Other unusual situations4,5

 

4 Recognition of Illness Associated with the Intentional Release of a Biologic Agent, MMWR 2001 Oct 

19;50(41):893-897.

5 Recognition of Illness Associated With Exposure to Chemical Agents — United States, 2003, MMWR 2003 

Oct 3;52(3):938-940.
17

1. Emergency Communications Channel – The program units for public health 

emergencies in the two countries, including their directors and directories, should 

be known to each other. Both program units should have a mechanism permitting 

direct contact on a continuous basis (i.e. 24 hours/day, 7 days/week, 365 

days/year).

2. Communication of a Suspected Incident – Suspicion of any intentional health 

incident which presents a risk to citizens of the other country should be urgently 

communicated to the counterpart agency responsible for such emergencies.

3. Ongoing Information Exchange – As such an incident evolves, information 

should be regularly exchanged at commonly decided intervals between 

corresponding public health emergency program units of both countries.

4. Resource Sharing in Emergencies – In preparation for such potential events, 

arrangements should be established between the public health authorities of the 

two countries – including local, state and federal levels – regarding the sharing of 

health resources during public health emergencies, together with expedited 

clearance procedures for cross–border transfer of such resources by immigration 

and custom officials, when such a public health emergency is formally declared.

5. Adherence to Outbreak Guidelines – Cooperation in the investigation of such 

incidents is strongly encouraged and should follow the same guidelines as for 

naturally occurring outbreaks.

6. Quarantine or Isolation of Foreign Citizens – In the event that quarantine or 

isolation are considered necessary by the public health agency of a country that 

will include citizens of the other country, subject to all other treaty or 

international law obligations, this decision should be communicated urgently to 

the counterpart public health agency of the other country. The public health 

agency enacting the quarantine or isolation should recognize the special needs of 

citizens of the other country who are caught outside their place of residence, while 

still ensuring the effectiveness of the quarantine or isolation measure.

5.4 Laboratory Issues

Laboratories serve a unique role in both surveillance and investigation of health 

problems. The purpose of this section is to establish guidelines for laboratories when 

significant health events of binational interest occur that will benefit from a collaborative 

response by both nations.

The availability of laboratories and the complexity of testing that those laboratories are 

capable of performing vary along the length of the border in the two countries. This may 

lead to periodic use of laboratories by border clinicians or patients in the neighboring 

country. In addition, disease outbreaks or emergency preparedness plans may lead to 

decisions to share laboratory resources. In such cases, minimizing the time required for 

laboratory diagnosis and confirmatory testing is critical to timely identification of health 

problems and disease outbreaks so that appropriate and timely control measures can be 
18

implemented. This is particularly important when considering bioterrorism events and 

outbreaks of highly communicable diseases such as pandemic influenza or Severe Acute 

Respiratory Syndrome (SARS) which have the potential to cause substantial health, 

social, and economic problems.

Each of the specific items detailed below should be addressed in establishing an efficient, 

highly functional, binational framework for laboratories to develop the needed 

capabilities for responding effectively to disease outbreaks and other health challenges 

impacting both countries.

1. Binational Reporting of Notifiable Diseases – When a laboratory in one country 

analyzes or examines specimens from a person residing in the other country, and 

obtains a positive result for a reportable condition, this information should be 

routinely communicated to the appropriate public health officials where the tested 

individual resides. The mechanism for making this communication should be 

determined by the respective state public health agencies working in coordination 

with relevant public and private laboratories and with its counterparts in the 

neighboring country. 

2. Transport of Laboratory Samples through Customs – In cases where 

specimens of public health interest need to be carried across the border for testing 

in a laboratory of the other country, mechanisms should be established to assure 

expedited passage through customs, since excessive delay may compromise the 

quality of the specimen and the ability to obtain an accurate diagnosis. This is 

likely to require the stimulus of prior coordination among the involved agencies, 

including the customs authority, specifying a clearly defined protocol to be 

followed for the rapid, cross-border transport of a set of specimens. 

3. Standards for Sample Transport – Specimens being sent for testing in the 

neighboring country should follow national and international standards for the 

labeling, packaging and transport of such material. In laboratories that may 

participate in such collaborative testing, specific training on implementation of 

these standards should be provided to responsible personnel in these areas, 

together with written instructions. 

4. Authorized Request for Laboratory Testing – Submission of samples for 

diagnostic testing by a laboratory of the neighboring country should be preceded 

by communication between authorized public health officials of the two countries, 

with approval of the receiving laboratory. Upon arrival of the specimen, 

confirmation should be sent to the agency submitting the specimens for testing. 

In situations where there is potential for the receiving laboratory to be sent a large 

number of specimens, a triaging policy should be established in anticipation to 

define the priority of received samples for urgent testing, and inform referring 

agencies of this policy. 

5. Reporting of Laboratory Results – Laboratory results should be communicated 

promptly to the requesting public health agency on a confidential basis. The 

agency submitting specimens for testing should be responsible for any public 
19

release of findings. When appropriate, specific protocols may be agreed upon 

which dictate alternate procedures. 

6. Binational Laboratory Collaboration – Collaborative activities between crossborder laboratories is encouraged to enhance the scope of diagnostic capabilities 

available and the quality of the services provided. This may include training, 

provision of equipment, supplies and/or reagents, and participation in quality 

assurance programs. For cross-border transport of specimens, agreements 

between regulatory, public health agencies and customs authorities should be 

promoted to define protocols which facilitate the passage of such material. Roles 

of national and state public health agencies for coordination of such activities 

should be defined by each country.

5.5 Public Health Risk Assessment and Communications

5.5.1 Risk assessment

Risk assessment is a fundamental element of effective public health response. Assessing 

the risk of public health events involves both quantitative and qualitative efforts to 

estimate the probability of harmful effects to populations from certain disease events or 

human activities. Risk assessments are formally conducted for Public Health 

Emergencies of International Concern reported to WHO using the International Health 

Regulations decision algorithms and by each country’s health agencies for a variety of 

situations, for example outbreaks that may lead to travel advisories, or emergency events 

caused by radiation. Each country should make every effort to share risk assessments for 

situations potentially affecting the neighboring country. In certain situations, such as 

events in border sister cities, joint risk assessments may be appropriate. Each country 

should make an effort to be responsive to a request from the neighboring country for a 

risk assessment on a situation for which that country indicates concern. Mechanisms for 

sharing risk assessments and making joint risk assessments when appropriate should be 

established. 

5.5.2 Communications

As expressed throughout this document, successful binational exchange of epidemiologic 

information for public health depends on timely and clear communication of accurate 

information between appropriate public health authorities of the U.S. and Mexico. 

Failure to do so can result not only in an inadequate public health response to prevent and 

control disease among binational populations, but also to misunderstandings between 

officials and the populations of both countries. Such misunderstandings can undermine 

mutual trust and confidence and can create distorted and unequal perceptions of the 

epidemiologic situation affecting the two countries. For these reasons, establishing clear 

mechanisms and protocols for public health communications between the two countries is 

of paramount importance.
20

Communications between Public Health Agencies or Institutions

1. Existing Information Sources – To facilitate the exchange of information 

recommended in this document, public health agencies should consult and 

subscribe to those information outlets provided by the other country (e.g. 

publications, press releases, Boletín Epidemiología, Health Alert Network, EpiX).

2. Communications between Public Health Agencies or Institutions – Direct 

communications between corresponding programs and staff of counterpart public 

health agencies or institutions of the neighboring country should be encouraged 

(e.g. to contact a known staff member in the measles unit to report a case of 

binational interest). However for cases in which program staff are not known or 

cannot be reached, or for emergencies and other broader issues of common 

interest, counterpart agencies of the two countries should each have a preestablished mechanism (telephone contact number and email address) which is 

staffed at all times for such communications. In the case of binational events 

requiring continued collaboration, the communications offices of counterpart 

agencies should be in regular contact, exchanging relevant information and 

coordinating the release of information to the public.

Release of Information to the Public

3. Harmonization of Public Information – In cases of binational epidemiologic 

events, information released to the public by the two countries regarding the 

event, risk factors and preventive measures should be consistent, based on the best 

available scientific evidence of the event itself, and the pathogens or substances 

involved. Ideally, the population of each country should receive such information 

from their public health authorities in the same time period, to avoid creation of 

unexpected demands on public health authorities from one-sided releases, and to 

reinforce their credibility to the public.

4. Sharing of Information for the Public – In the case of a binational public health 

emergency or outbreak affecting the population of both countries, copies of 

information made available to the public by the respective public health agency 

should be shared with the counterpart agency of the other country. In nonemergency circumstances, such information should be made available on request.

5. Travel Notices – Travel notices are posted by public health authorities to provide 

information to travelers, the public, healthcare providers and public health 

authorities regarding outbreaks of disease of public health significance. The 

character of the notification is based on four criteria relating to disease 

transmission, containment measures, quality of surveillance, and quality and 

accessibility of medical care. In the case of such travel notices or other 

communications to the public which could have negative impact on trade, tourism

or other industries, the counterpart agency should be given prior notice of the 

action to be taken and the evidence supporting that decision for their review and, 
21

if appropriate, their response. The IHR (2005) should be always considered when 

making these decisions.

6. Next Steps

The intent of the two countries is that the completion of these Guidelines be followed by 

the elaboration of a set of protocols to guide the implementation of these 

recommendations by the public health agencies or institutions of each country. This 

process should be undertaken with broad binational participation of the major public 

health agencies or institutions at the state and federal levels. 

Finally, based on the experience accumulated in the functional implementation of the 

Guidelines to date, it appears likely that they will evolve over time, and new or revised 

needs will be identified. In anticipation of this, a binational technical working group 

should review this document annually, to assess its continued validity, and to update the 

Guidelines as needed. Nevertheless, these Guidelines will remain applicable as long as 

no other document of a similar nature modifies them.

May 2012
22

Acknowledgments

These Guidelines were developed by the Core Group on Epidemiologic Surveillance of the Health Working 

Group, U.S.-Mexico Binational Commission and subsequently refined by the U.S. Centers for Disease 

Control and Prevention (CDC), Department of Health and Human Services (HHS) and by the General 

Directorate of Epidemiology (DGE), Secretaria de Salud (SSA), Mexico. 

Dr. Celia Alpuche-Aranda, Assistant Director General of the Institute of Epidemiological Diagnosis and 

Reference (InDRE), SSA, Mexico

Dr. Hugo Lopez-Gatell, Assistant Director General, DGE, SSA, Mexico. 

Jay McAuliffe, Office of the Associate Director for Policy, Center for Global Health, CDC, HHS

Stephen Waterman, Division of Global Migration and Quarantine, National Center for Zoonotic and 

Emerging Infectious Diseases (NCEZID), CDC, HHS

An earlier version was written in 2004 coordinated in Mexico by: 

Dr. Pablo Kuri Morales, former Assistant Director General of Epidemiology, Secretaria de Salud

Dr. Cuauhtemoc Mancha, former Director of Information at DGE, Secretaria de Salud

The following individuals have contributed significantly to the drafting and/or review of this document:

Dr. Norma Luna, DGE, SSA, Mexico. 

Dr. Ethel Palacios Zavala, formerly DGE, SSA, Mexico.

Rita Flores León, InDRE, SSA, Mexico 

Dr. Rigoberto Aranda, formerly General Directorate of Social Communication, SSA

Miguel Betancourt, formerly DGE, SSA

Chris Braden, Director, Division of Foodborne, Waterborne, and Environmental Diseases, (DFWED), 

NCEZID, CDC, HHS

Gil Chavez, Council of State and Territorial Epidemiologists

Joanne Cono, Office of Infectious Diseases, CDC, HHS

María Esther Díaz, Federal Commision for the Protection Against Sanitary Risks (COFEPRIS), SSA

RJ Dutton, Office of Border Health, Texas Department of State Health Services

M B Elvira Espinosa Gutiérrez, formerly COFEPRIS, SSA

Jack Guzewich, Center for Food Safety and Applied Nutrition, FDA, HHS

Eva Holland, Office of the General Counsel, CDC, HHS

Luis Anaya, formerly DGE, SSA

Richard Kellogg, Division of Bioterrorism Preparedness and Response, NCEZID, CDC, HHS

Karl Klontz, Center for Food Safety and Applied Nutrition, FDA, HHS

Jim Misrahi, Office of the General Counsel, CDC, HHS

Ellen Morrison, Office of the Commissioner, FDA, HHS

Chris Peter, formerly County of San Diego Department of Health and Human Services

Morris Potter, Center for Food Safety and Applied Nutrition, FDA, HHS

Julie Rawlings, Office of the State Epidemiologist, Texas Department of State Health Services

Alfonso Rodriguez, formerly California Department of Health

Shah Roohi, Division of Global Migration and Quarantine, NCEZID, CDC, HHS

Don Sharp, Food Safety Program, NCEZID, CDC, HHS

Dan Stier, formerly Public Health Law Program, CDC, HHS

Rob Tauxe, Deputy Director, DFWED, NCEZID, CDC, HHS

Ignacio Villaseñor, formerly InDRE, SSA

Michelle Weinberg, Division of Global Migration and Quarantine, NCEZID, CDC, HHS

Chad Wood, formerly Emergency Communication Branch, National Center for Health Marketing, HHS

Maureen Fonseca-Ford, Division of Global Migration and Quarantine, NCEZID, CDC, HHS
23

Annex: Mexico’s Legal Framework for Epidemiologic Surveillance

1. Constitution of Mexico

Article 4. Fourth paragraph.

2. Laws

General Health Law.

Articles: 17B, 133, part II, Chapter II of “Infectious Diseases” 134 to 157, 181, 353, 358, 

359, 360 and 408 and others relating to epidemiologic issues. 

Federal Law for the Control of Chemical Precursors, Essential Chemical Products and 

Machinery for Producing Capsules, Tablets and Pills

Official Journal of the Federation 26 Dec 1997.

Biosafety Law on Genetically Modified Organisms

Official Journal of the Federation 18 Mar 2005.

Customs Law

Official Journal of the Federation 15 Dec 1995.

Organic Law of Federal Public Administration

Official Journal of the Federation 29 Dec 1976

Last Alteration Official Journal of the Federation 17 Jun 2009.

Federal Law of Transparency and Access to Public Governmental Information

Official Journal of the Federation 11 June 2002

Last Alteration Official Journal of the Federation 05 Jul 2010.

General Law of Civil Defense

Official Journal of the Federation 12 May 2000

Last Alteration Journal of the Federation 24 Apr 2006.

Federal Law for Protection of Personal Data Held by Individuals 

Official Journal of the Federation 05 Jul 2010.

3. Regulations 

Regulation of the General Health Law regarding International Sanitary Issues. 

Official Journal of the Federation 18 Feb 1985.

Errata Official Journal of the Federation 10 Jul 1985.

Regulation of the General Health Law regarding Sanitary Control for the Disposition of 

Organs, Tissues, and Human Cadavers.

Official Journal of the Federation 20 Feb 1985.

Errata Official Journal of the Federation 09 Jul 1985.

Alterations Official Journal of the Federation 26 Nov 1987.

2
24

Regulation of the General Health Law regarding Delivery of Medical Care Services.

Official Journal of the Federation 14 May 1986.

Alterations Official Journal of the Federation 04 Dec 2009

Regulation of the General Health Law regarding Health Research.

Official Journal of the Federation 06 Jan 1987.

Regulation of the General Health Law regarding Public Health Control of Activities, 

Establishments, Products and Services.

Official Journal of the Federation 18 Jan 1988.

Alterations Official Journal of the Federation 28 Apr 2004

Regulation on Health Supplies 

Official Journal of the Federation 04 Feb 1998.

Corrections Official Journal of the Federation 05 Aug 2008.

Regulation on Public Health Control of Products and Services.

Official Journal of the Federation 09 Aug 1999.

Alterations Official Journal of the Federation 6 Apr 2006

Regulation on Registrations, Authorizations of Importation and Exportation and Export 

Certificates of Insecticides, Plant Nutrients and Substances and Toxic or Dangerous 

Materials.

Official Journal of the Federation 28 Dec 2004.

Regulation on Customs Law

Official Journal of the Federation 06 Jun 1996

Last Alteration Official Journal of the Federation 28 Oct 2003.

Regulation on the Law of Biosecurity for Genetically Modified Organisms

Official Journal of the Federation 19 Mar 2008

Last Alteration Official Journal of the Federation 02 Jun 2009

Regulation on the Federal Law for the Control of Chemical Precursors, Essential 

Chemical Products and Machinery for Producing Capsules, Tablets and Pills 

Official Journal of the Federation 15 Sep 1999

Regulation on the Federal Law of Transparency and Access to Public Governmental 

Information

Official Journal of the Federation 11 Jun 2004

Internal Regulations of the Secretariat of Health

Official Journal of the Federation 19 Jan 2004

Last Alterations Official Journal of the Federation 29 Nov 2006, 02 Feb 2010, 10 Jan 

2011.
25

4. Plans and Programs

National Development Plan 2007-2012.

Official Journal of the Federation 31 May 2007.

Health Sector Program 2007-2012

Official Journal of the Federation 17 Jan 2008.

5. Decrees

Decree which establishes the basis of coordination for the Secretaries of Commerce and 

Industry, of Agriculture and Water Resources, of Urban Development and Ecology and 

of Health, that should be observed in regard to Insecticides, Fertilizers, and Toxic 

Substances.

Official Journal of the Federation 15 Oct 1987.

Decree by which is created the National Vaccination Council 

Official Journal of the Federation 24 Jan 1991.

Corrections Official Journal of the Federation 05 Jul 2001.

Decree by which is changed the National Council for AIDS Prevention and Control.

Official Journal of the Federation 05 Jul 2001.

Decree by which is created the National Bioethics Council.

Official Journal of the Federation 07 Sep 2005.

6. Executive Agreements

Agreement by which is created the Inter-Institutional Commision on Health Research.

Official Journal of the Federation 19 Oct 1983.

Agreement by which is created the National Committee for Health Security

Official Journal of the Federation 23 Sep 2003.

Agreement by which is established the Integration and Objectives of the National Health 

Council.

Official Journal of the Federation 27 Jan 2009.

7. Secretarial Agreements 

Agreement Number 43. By which is created the Health Research Committee.

Official Journal of the Federation 11 Jan 1985.

Agreement by which instructions are made known for the uniform and comprehensive 

procedure to which is subjected the Secretaries of Commerce and Industry, of Agriculture 

and Water Resources, of Urban Development and Ecology, in the resolution of requests 

for authorizations for licenses, permissions, and registries of insecticides, fertilizers, and 

toxic substances. 
26

Official Journal of the Federation 07 Dec 1988.

Agreement Number 130. By which is created the National Committee for Epidemiologic 

Surveillance.

Official Journal of the Federation 06 Sep 1995.

Agreement that establishes the classification and coding of merchandise whose 

importation is subject to regulation by those agencies which make up the the InterSecretarial Commision for the Control of the Process and Use of Inecticides, Fertilizers, 

and Toxic Substances.

Official Journal of the Federation 29 Mar 2002.

Last modifications Official Journal of the Federation 01 Apr 2005, 26 May 2008, 25 Aug 

2010.

Agreement by which is established certification of the geographic areas that have 

achieved elimination of transmission of canine rabies. 

Official Journal of the Federation 16 Mar 2004.

Agreement by which is established certification of the geographic areas which have 

achieved elimination of transmission of malaria. 

Official Journal of the Federation 16 Mar 2004.

Agreement by which is created the National Committee of the Tuberculosis Action 

Program.

Official Journal of the Federation 16 Mar 2004.

Agreement by which is made known the instructions and forms for the authorization of 

importation and exportation of insecticides, plant nutrients and dangerous substances and 

materials.

Official Journal of the Federation 15 Sep 2005.

Agreement by which is made known the instructions and forms for the authorization of 

importation and exportation of insecticides, plant nutrients and dangerous substances and 

materials.

Official Journal of the Federation 15 Sep 2005.

Agreement through which all the institutions of the national health system in its public, 

social, and private levels of medical services, must immediately notify the Secretariat of 

Health of probable cases of influenza meeting the case definition established by the 

Secretariat of Health. 

Official Journal of the Federation 02 May 2009

Agreement which establishes the classification and codification of merchandise and 

products whose importation, exportation, entrance or exit is subject to the sanitary 

regulation of the Secretariat of Health. 

Official Journal of the Federation 27 Sep 2007

Modification Official Journal of the Federation 01 Jun 2010
27

8. Decisions of the General Public Health Council 

Agreement by which is established that public institutions of the national health system 

should purchase interchangeable generic medications.

Official Journal of the Federation 07 Jun 2002.

Basic List and Catalog of Medications, Edition 2010.

Official Journal of the Federation 13 May 2011.

First Update Official Journal of the Federation 10 Jun 2011

Second Update Official Journal of the Federation 20 Jul 2011

Third Update Official Journal of the Federation 11 Aug 2011

Fourth Update Official Journal of the Federation 24 Oct 2011

Basic List and Catalog of Biological Products and Reagents of the Health Sector 1997.

Official Journal of the Federation 29 Sep 1997.

First update Official Journal of the Federation 16 Mar 1998.

Second update Official Journal of the Federation 20 Jul 1998.

Third update Official Journal of the Federation 06 May 1999.

Fourth update Official Journal of the Federation 22 Dec 1999.

Fifth update Official Journal of the Federation 03 Nov 2000.

Sixth update Official Journal of the Federation 13 Mar 2002.

Seventh update Official Journal of the Federation 12 Apr 2002.

Eighth update Official Journal of the Federation 06 Aug 2002.

Catalog of Interchangeable Generic Medications 

Official Journal of the Federation 17 Aug 1998.

And its subsequent updates published in the Official Journal of the Federation

Agreement by which is established the Prevention and Health Promotion Strategy during 

the Stages of Life.

Official Journal of the Federation 23 Oct 2003.

Basic List and Catalog of Diagnostic Materials, Edition 2010.

Official Journal of the Federation 09 May 2011.

First update Official Journal of the Federation 07 Sept 2011.

Agreement by which is established the Commission for Definition of Treatments and 

Medications Associated with Diseases that Result in Catastrophic Costs.

Official Journal of the Federation 28 Apr 2004.

Agreement by which is established the obligatory application in the public and private 

institutions of the National Health System, of the substantive and strategic components 

and components of the Action Program Start Out Even in Life and of epidemiologic 

surveillance of maternal deaths.

Official Journal of the Federation 01 Nov 2004.

Agreement by which are established the general obligatory measures for the prevention, 

care and control of HIV/AIDS in the public institutions of the National Health System.
28

Official Journal of the Federation 12 Nov 2004.

9. Official Mexican Norms

Included here are all the Official Mexican Norms emitted to the present, but as per

federal law, these are in effect for five years from the date of emission, in which time 

they need to be revised or will become inactive. 

A) National Advisory Committee on Standardization of Public Health Regulation 

and Promotion. SSA1.

Official Mexican Norm NOM-003-SSA2-1993, on the use of human blood and its 

components for therapeutic ends.

Official Journal of the Federation 18 Jul 1994.

Errata Official Journal of the Federation 23 Feb 1996.

Clarification Official Journal of the Federation 08 Sep 1994.

Official Mexican Norm NOM-230-SSA1-2002, Environmental health. Water for human 

use and consumption, public health requirements that private and public supply systems 

of water should follow. Public health procedures for sampling. 

Official Journal of the Federation 12 Jul 2005.

Official Mexican Norm NOM-020-SSA1-1993,Environmental Health. Criteria for 

evaluating air quality in regard to ozone (O2). The level of ozone concentration defined 

as a measure of protection of the population’s health. 

Official Journal of the Federation 23 Dec 1994.

Project Modification Official Journal of the Federation 31 Jul 2000.

Official Mexican Norm NOM-022-SSA1-1993 Environmental Health. Environmental 

criteria for evaluating air quality in regard to sulfur dioxide (SO2). The level of sulfur 

dioxide (SO2) in ambiental air as a measure of protection of the population’s health. 

Official Journal of the Federation 23 Dec 1994.

Official Mexican Norm NOM-59-SSA1-1993, good production practices for chemicalpharmaceutical establishments engaged in the production of medications.

Official Journal of the Federation 31 Jul 1998.

Clarification Official Journal of the Federation 01 Feb 1999.

Official Mexican Norm NOM-115-SSA1-1994, Goods and Services. Method for 

determining the presence of staphylococcus aureus in foods.

Official Journal of the Federation 25 Sep 1995.

Official Mexican Norm NOM-199-SSA1-2000, Environmental Health. Levels of lead in 

blood and actions as criteria to protect the health of populations exposed occupationally.

Official Journal of the Federation 18 Oct 2002.

Official Mexican Norm NOM-220-SSA1-2002, Installation and operation of 

pharmacosurveillance.
29

Official Journal of the Federation 15 Nov 2004.

B) National Advisory Committee of Standards for Disease Prevention and Control.

Official Mexican Norm NOM-006-SSA2-1993 for the prevention and control of 

tuberculosis in primary health care.

Official Journal of the Federation 26 Jan 1995.

Modification Official Journal of the Federation 31 Oct 2000.

Modification Project Official Journal of the Federation 02 Sep 2004.

Modification Official Journal of the Federation 27 Sep 2005.

Official Mexican Norm NOM-010-SSA2-1993, for the prevention and control of HIV 

infection.

Official Journal of the Federation 17 Jan 1995.

Modification Project Official Journal of the Federation 22 Sep 1999.

Modification of the Norm Official Journal of the Federation 21 Jun 2000.

Official Mexican Norm NOM-011-SSA2-1993, for the prevention and control of rabies.

Official Journal of the Federation 25 Jan 1995.

Modification Official Journal of the Federation 24 Jan 2001.

Official Mexican Norm NOM-016-SSA2-1994, for the surveillance, prevention, control 

and treatment of cholera.

Official Journal of the Federation 05 Oct 2000.

Official Mexican Norm NOM-017-SSA2-1994, for epidemiologic surveillance.

Official Journal of the Federation 11 Oct 1999.

Official Mexican Norm NOM-021-SSA2-1994, for the surveillance, prevention, and 

control of the tenia/cysticercosis complex in primary health care.

Official Journal of the Federation 21 Aug 1996.

Modification Project: Official Journal of the Federation 11 Sep 2000.

Official Mexican Norm NOM-021-SSA2-1994, for the prevention and control of the 

teniasis/cysticercosis in primary health care.

Modification Official Journal of the Federation 21 May 2004.

Official Mexican Norm NOM-022-SSA2-1994, for the prevention and control of 

brucellosis in man in primary health care. 

Official Journal of the Federation 30 Nov 95.

Modification Project: D.O.F: 27 Jun 2000.

Modification Official Journal of the Federation 02 Feb 2001.

Official Mexican Norm NOM-026-SSA2-1998, for epidemiologic surveillance, 

prevention and control of nosocomial infections.

Official Journal of the Federation 26 Jan 2001.

Notice of Cancellation Official Journal of the Federation 26 Nov 2003.
30

Official Mexican Norm NOM-027-SSA2-2007, for the prevention, control and 

elimination of leprosy.

Official Journal of the Federation 12 Aug 2009

Official Mexican Norm NOM-029-SSA2-1999, for epidemiologic surveillance, 

prevention and control of leptospirosis in man.

Official Journal of the Federation 02 Feb 2001.

Official Mexican Norm NOM-032-SSA2-2002, For the epidemiologic surveillance, 

prevention and control of vector-borne diseases. 

Official Journal of the Federation 21 Jul 2003.

Official Mexican Norm NOM-036-SSA2-2002, Prevention and control of diseases. 

Application of vaccines, toxoids, sera, antitoxins, and immunoglobulins in man.

Official Journal of the Federation 17 Jul 2003.

Clarification Official Journal of the Federation 20 Jan 2004.

Official Mexican Norm NOM-039-SSA2-2002, For the prevention and control of 

sexually transmitted infections.

Official Journal of the Federation 19 Sep 2003.

Official Mexican Norm NOM-041-SSA2-2002, For the prevention, diagnosis, treatment, 

control and epidemiologic surveillance of breast cancer.

Official Journal of the Federation 17 Sep 2003.

Official Mexican Norm NOM-042-SSA2-2006, For the prevention and control of 

diseases. Public health specifications for canine veterinary services. 

Official Mexican Norm NOM-045-SSA2-2005, For epidemiologic surveillance, 

prevention and control of nosocomial infections.

Official Journal of the Federation 20 Nov 2009.

10. Other Juridical Orders 

Criteria for the certification of geographic areas that have achieved elimination of canine 

rabies transmission.

Official Journal of the Federation 19 Aug 2005.

Criteria for the certification of geographic areas that have achieved the elimination of 

malaria transmission.

Official Journal of the Federation 10 Apr 2006.

General rules regarding exterior commerce for 2011.

Official Journal of the Federation 29 Jul 2011.
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11. International Decisions 

Decree by which is approved Prohibition of the Development, Production and Storage of 

Bacterial Weapons (Biologic) and Toxins and on their Destruction; approved during the 

XVI normal session during the United Nations General Assembly.

Official Journal of the Federation 04 Apr 1973.

Enactment Decree of the Convention on the Prohibition of the Development, Production, 

Storage and Use of Chemical Weapons and on their Destruction.

Official Journal of the Federation 05 Oct 1994.

Decree by which is approved the Cartagena Protocol on the Security of Biotechnology of 

the Convention on Biologic Diversity, adopted in Montreal, on January 21, 2000.

Official Journal of the Federation 01 Jul 2002.