are few in number and have rarely been added to in the last 20 years. the most common forms of control are educating the public and vector control. the huge geographic area of the vectors anopheles is possibly the largest challenge faced in the control of malaria. with such a large area to cover it is hard to use insecticides at a continuous and effective level. this form of control is expensive, and the areas affected are not able to sustain control. without sustained control, a rapid resurgence in parasite transmission is seen. another challenge with insecticides is that the vector is becoming insecticide resistant. mosquitoes have several generations per year so resistance is seen very quickly. education has its limitations as well, as the population most affected by malaria are children, and the educational message is to stay inside during peak mosquito activity. the low socioeconomic status of the people who inhabit the african highlands is also a challenge. local health facilities have limited resources, and poor living conditions and malnourishment exacerbate malaria symptoms and increase the likelihood of death due to malaria. as climate change shifts geographic areas of transmission to the african highlands, the challenge will be to find and control the vector in areas that have not seen it before, and to not waste resources on areas where the temperature is no longer conducive to parasite growth. a number of groups are working on a vaccine—some are looking to control the transmission of the parasite to the host, or control transmission from human back to the vector. these vaccines are not very effective, and lose their effectiveness over time, so are not ideal. but the development is still progressing in the hopes of finding a better, more effective long-lasting vaccine. an alternative to vaccines is vectored immunoprophylaxis (vip) that is a form a gene therapy. this therapy will change cells in the host that will secrete antigens from various stages of the parasite in the hopes of triggering an anamnestic immune response in the recipient, prevent disease and parasite transmission. policy implications the policy implications of climate change and malaria rates in the african highlands fall into two categories: enacting policy that will reduce greenhouse gas emissions, thus slowing down climate change, and mitigating problems that have already arisen, and will inevitably continue to develop, due to climate change. addressing both of these areas is of importance, as those in the poorest countries, including countries that make up the african highlands, face the greatest burden. additionally, when countries are forced to contend with a disease like malaria, their prospects for economic growth are slowed. this contributes to continued and worsening global inequality. when one focuses on mitigation, specifically as it relates to malaria in the african highlands, research is still an important component. this research needs to take many forms, including attribution studies, to find the degree to which climate change effects malaria rates; scenario modeling, which can help further our understanding of future climate change consequences on malaria rates; and examinations of intervention programs and techniques, to help our understanding of what appropriate responses are. surveillance and monitoring of malaria in populations in the african highlands will also be important, to better understand disease. policies are required that will significantly increase investments in public health in the african highlands. this achieves two goals, the first being better outcomes related to malaria in the affected area, and the second being an overall better health environment for populations. it is also important to focus on "one-health approaches." this means collaborating on an interdisciplinary level, across various geographic areas, to come up with workable solutions. non-climatic determinants sociodemographic factors include, but are not limited to: patterns of human migration and travel, effectiveness of public health and medical infrastructure in controlling and treating disease, the extent of anti-malarial drug resistance and the underlying health status of the population at hand. environmental factors include: changes in land-use (e.g. deforestation), expansion of agricultural and water development projects (which tend to increase mosquito breeding habitat), and the overall trend towards urbanization (i.e. increased concentration of human hosts). these changes in landscape can alter local weather more than long term climate change. for example, the deforestation and cultivation of natural swamps in the african highlands has created conditions favorable for the survival of mosquito larvae, and has, in part, led to the increasing incidence of malaria. the effects of these non-climatic factors complicate things and make a direct causal relationship between climate change and malaria difficult to confirm. it is highly unlikely that climate exerts an isolated effect. dengue fever dengue fever is an infectious disease caused by dengue viruses known to be in the tropical regions. it is transmitted by the mosquito aedes, or a. aegypti. dengue incidence has increased in the last few decades and is projected to continue to do so with changing climate conditions. once infected with the dengue virus, humans experience severe flu-like symptoms. also known as "break-bone fever", dengue can affect infants, children, and adults and can be fatal. dengue fever is spread by the bite of the female mosquito known as aedes aegypti. the female mosquito is a highly effective vector of this disease. climate change has created conditions favorable to the spread of the dengue virus. transmission peaks during the rainy season when mosquitoes breed. the world health organization (who) has reported an increase from a thousand to one million confirmed cases between 1955 and 2007. the presence and number of aedes aegypti mosquitoes is strongly influenced by the amount of water-bearing containers or pockets of stagnant water in an area, daily temperature and variation in temperature, moisture, and solar radiation. while dengue fever is primarily considered a tropical and subtropical disease, the geographic ranges of the aedes aegypti are expanding. the recent spread of this primary vector of dengue is attributed to globalization, trade, travel, demographic trends, and warming temperatures. dengue is ranked as the most important vector-borne viral disease in the world. an estimated 50–100 million dengue fever infections occur annually. in just the past 50 years, transmission has increased drastically with new cases of the disease (incidence) increasing 30-fold. once localized to a few areas in the tropics, dengue fever is endemic in over 100 countries in southeast asia, the americas, africa, the eastern mediterranean, and the western pacific with southeast asia and the western pacific regions being the most seriously affected. the number of reported cases has continually increased along with dengue spreading to new areas. explosive outbreaks are also occurring. moreover, a possible threat of outbreak exists in europe with local transmission of dengue being reported for the first time in france and croatia in 2010. one country that has seen significant impacts from dengue is bangladesh. the cases of dengue fever have increased dramatically since the 1970s and it continues to become more prevalent. the greater incidence of this disease is believed to be due to a combination of urbanization, population growth, increased international travel, and climate change. the same trends also led to the spread of different serotypes of the disease to new areas, and to the emergence of dengue hemorrhagic fever. four viruses can cause dengue fever exist. if someone is infected with one type of dengue virus, he or she will have permanent immunity to that type of dengue virus but will have short term immunity to the other type of dengue fever. some of the symptoms of dengue fever are fever, headache, muscle and joint pains and skin rash. dengue fever used to be considered a tropical disease, but climate change is causing dengue fever to spread. dengue fever is transmitted by certain types of mosquitoes, which have been spreading further and further north. this is because some of the climate changes that are occurring are increased heat, precipitation and humidity which create prime breeding grounds for mosquitoes. the hotter and wetter a climate is, the faster the mosquitoes can mature and the faster the disease can develop. another influence is the changing el nino effects that are affecting the climate to change in different areas of the world, causing dengue fever to be able to spread. "some 1.8 billion (more than 70%) of the population at risk for dengue worldwide live in member states of the who south-east asia region and western pacific region, which bear nearly 75% of the current global disease burden due to dengue. the asia pacific dengue strategic plan for both regions (2008—2015) has been prepared in consultation with member countries and development partners in response to the increasing threat from dengue, which is spreading to new geographical areas and causing high mortality during the early phase of outbreaks. the strategic plan aims to aid countries to reverse the rising trend of dengue by enhancing their preparedness to detect, characterize and contain outbreaks rapidly and to stop the spread to new areas." tick borne disease tick-borne disease, which affect humans and other animals, are caused by infectious agents transmitted by tick bites. a high humidity of greater than 85% is ideal for a tick to start and finish its life cycle. studies have indicated that temperature and vapor play a significant role in determining the range for tick population. more specifically, maximum temperature has been found to play the most influential variable in sustaining tick populations. higher temperatures augment both hatching and developmental rates while hindering overall survival. temperature is so important to overall survival that an average monthly minimum temperature of below -7 °c in the winter can prevent an area from maintaining established populations. the effect of climate on the tick life cycle is one of the more difficult projections to make in relation to climate and vector-borne disease. unlike other vectors, tick life cycles span multiple seasons as they mature from larva to nymph to adult. further, infection and spread of diseases such as lyme disease happens across the multiple stages and different classes of vertebrate hosts, adding additional variables to consider. although it is a european species from the lyme borreliosis spirochetes, borrelia garinii was documented from infected ticks on seabirds in north america. further research is needed to improve evolutionary models predicting distributional changes in this tick-borne system in the face of climate change. infection of ticks happen in the larval/nymph stage (after the first blood meal) when they are exposed to borrelia burgdorferi (the spirochete responsible for lyme disease), but transmission to humans doesn't occur until the adult stages. the expansion of tick populations is concurrent with global climatic change. species distribution models of recent years indicate that the deer tick, known as i. scapularis, is pushing its distribution to higher latitudes of the northeastern united states and canada, as well as pushing and maintaining populations in the south central and northern midwest regions of the united states. climate models project further expansion of tick habit north into canada as progressing northwest from the northeastern united states. additionally, however, tick populations are expected to retreat from the southeastern coast of the u.s., but this has not yet been observed. it's estimated that coinciding with this expansion, increased average temperatures may double tick populations by 2020 as well as bring an earlier start to the tick exposure season. tick populations are not only spreading wider but moving to higher elevations. in colorado, the rocky mountain wood tick known as d. andersoni is found along the front range and is wont to feed on, and consequently infect, human populations with tularemia (francisella tularensis), rocky mountain spotted fever (rickettsia rickettsii), and colorado tick fever (ctf virus). a case study testing climatic interaction affecting tick vector (d. andersoni) populations in larimer county, colorado indicated that an estimated increase of 1.2–2.0 °c in summer temperatures would increase tick populations moving 100m upwards in elevation, increasing the range and susceptibility of tick-borne illnesses along the front range. with regard to the effects of a warming world and the expansion of tick populations to previously unexposed areas, adaptive keys to prevention will include expansion of health care infrastructure and pharmacologic availability, as well as education of people and providers as to the risks of disease and preventive measures they can take. in the face of these expanding threats, strong collaboration between government officials and environmental scientists is necessary for