Typhoid, paratyphoid, and enteric infections between 1872 and 2023 in Bremen, Germany

• Bremen case study; over 150 years of reporting communicable diseases; effect of hygienic and infection control measures; reduction of typhoid, paratyphoid and dysentery cases. As a German federal state, Bremen introduced reporting of infectious diseases as early as 1872. Therefore, it is a favourable model to study the effects of early hygienic and public health measures on the distribution of communicable diseases. In the city of Bremen, the introduction of a central drinking water supply using sand filtration was accompanied by a sharp decline in reported typhoid cases. Other measures included the continuous improvement of the sewage system, food monitoring, the construction of a central slaughterhouse, the opening of public baths, and the establishment of a hygienic institute with a disinfection facility. Because the cities of Bremen and Bremerhaven were important ports for emigration, additional measures were taken in related fields. Typhoid outbreaks in the town of Bremen were linked to flooding and contaminated milk supplies. Possibly, the increasing case numbers were also a result of improved contact tracing. A significant outbreak of paratyphoid in the years 1959/60 was believed to be related to food. Large outbreaks of dysentery occurred in 1904 and 1917/18, at the end of World War I. The last reported outbreak of cholera in the city was in 1866. During the major Hamburg outbreak in 1892, only a few cases of cholera were identified. A clear negative impact of World War I and World War II on the infection situation can be observed. In recent decades, only a few cases of typhoid, paratyphoid, or dysentery have been reported per year at most. The historic pathways of transmission that are described can still be found in developing countries. Therefore, the measures and infrastructure developments in Bremen serve as an example of successful hygienic interventions.