President Enrique Peña Nieto said more than 20 children had died and 30 were missing after a school collapsed.
The 7.1 magnitude quake also caused major damage in neighbouring states.
The tremor struck shortly after many people had taken part in an earthquake drill, exactly 32 years after a quake killed thousands in Mexico City.
The country is prone to earthquakes and earlier this month an 8.1 magnitude tremor in the south left at least 90 dead.
What is the death toll across Mexico?
The epicentre of the latest quake was near Atencingo in Puebla state, about 120km (75 miles) from Mexico City, with a depth of 51km, the US Geological Survey said.
An earlier death toll of nearly 250 was lowered to 216 by the country's national co-ordinator for civil protection:
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