During the 20th century, the advent of vaccines and antibiotics, and continued improvements in urban sanitation and water quality resulted in a dramatic decline in mortality due to infectious diseases. There was a brief period of optimism in the mid-1900's that infectious pathogens would no longer be a significant cause of death in the United States. For a number of reasons, this trend had reversed by the end of the century, and the rates of death caused by infectious diseases began rising. in recognition of this change, the Institute of Medicine issued a report in 1992 that called attention to the major factors contributing to the emergence and reemergence of infectious diseases. Among these were the following: increased human encroachment on wilderness habitats, resulting in changes in the ecosystem and increased contact with animal and insect vectors which may harbor unknown infectious agents; sizable growth in human population, resulting in increased urbanization and crowding; increased global travel; changes in human behaviors; and microbial evolution.