Cholera in Mexico: the paradoxical benefits of the last pandemic.

OBJECTIVES: To describe the impact of preventive and control measures in Mexico prior to, and during, the cholera epidemic of 1991-2001.
METHODS: When cholera appeared in Latin America in January 1991, the Mexican government considered that it represented a national security problem. Therefore, actions were implemented within the health sector (e.g. epidemiological surveillance, laboratory network and patient care) and other sectors (public education and basic sanitation).
RESULTS: The first case occurred in Mexico in June 1991. The incidence rate remained below 17.9 per 100,000 inhabitants and affected mainly rural areas. The last cholera report occurred in 2001. The disease never became endemic. The population benefited not only from acquisition of knowledge about preventive measures, but also from modification of risky practices and from reinforcement of city and municipal drinking water supplies.
CONCLUSION: Control strategies had an overall impact in decreasing diarrheal mortality among children under five years of age. Additionally the country did not suffer from a decrease in tourism or economic consequences. This experience can be considered as the operationalization of a new public health system spanning multisectorial activities, involving community participation, political will and with impact on public health and economic issues.