After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.