The first phase of "Operation Vaccinate Florida," which is intended to protect Floridians from a terrorist-spawned smallpox epidemic, has been approved by the National Centers for Disease Control and Prevention.

The state's three-pronged plan -- part of a national effort launched by President George W. Bush -- begins Jan. 24 when Florida's 35,000 health care and hospital workers will be offered vaccinations against the smallpox virus.

Monroe County Department of Health Administrator Dr. Jake Rutherford said the county is prepared to begin Phase 1.

He said the plan has been in place for months but the real test will come with its execution.

"It is one thing to have it all on paper, and it is another thing to actually do it," Rutherford said. "I have a healthy bit of skepticism, so I think I'm a little nervous."

Smallpox is a highly contagious virus that is spread from person to person, historically killing about 30 percent of its victims. People can prevent infection if they are vaccinated within four days of exposure, before symptoms even appear. Afterwards, it is too late, and there is no treatment.

The vaccine, however, is not without risks. About 15 out of every one million people vaccinated for the first time will face life-threatening complications.

"At this point, I would not get vaccinated," said Dr. Stanley Zuba, an Upper Keys pediatrician and chief Mariners Hospital's medical staff. "We're in a relatively low-risk area. If there was an outbreak in a major U.S. city, we would take the vaccine, but we are unlike a big city. We will hold off until there is a clear risk.

"I think right now the risk of taking the vaccine outweighs the risk of a smallpox outbreak," he said. "Until I see some proof that we're in danger, we will hold off."

Mariners Hospital spokesperson Jill Miranda-Baker said Baptist Health, with which the Tavernier hospital is affiliated, is in the process of finalizing its internal plan.

"We are working with the local health department as well as the state health department," she said.

Marilyn Roznowski, an infection control nurse for Fishermen's Hospital, says the Marathon hospital is in the process of obtaining the names of doctors and nurses who wish to volunteer for the inoculation.

"We are currently waiting for training from the new Monroe County bioterrorism officer, George Colson," Roznowski said.

When asked about that training, Colson cited the "sensitive and confidential" nature of the vaccination effort. After checking with Tallahassee, he said the county has submitted its plan to the Florida Department of Health.

"I can say that we were asked to prepare a plan for this event. We did and then submitted it to the state, which, in turn, sent each county's plan to the Center for Disease Control in Atlanta," Colson said. "Their reaction was that Florida's plan is exemplary."

Phase 2 follows in March, when 400,000 police, firefighters and EMS personnel may receive vaccinations. The third phase, expected to begin next January, will offer up to 10 million of Florida's 16 million residents an opportunity to receive the vaccine.

The vaccinations are offered on a voluntary basis.

Since it has been 30 years since the vaccine was last administered, health care workers will have to be taught proper methods for administering the smallpox vaccine, according to Colson.

Typical side effects from the vaccine, which is made with a live virus, include sore arms, fever and swollen glands. About 10 percent experience extreme discomfort, with fatigue or flu-like symptoms.

Not everyone will be eligible to receive the vaccinations, according to state guidelines.

People with skin conditions such as eczema or severe acne or impaired immune systems or women who are pregnant or plan to become pregnant within a month should not be vaccinated. Nor should anyone who lives in the same household with anyone with those conditions or where children younger than age 1 live.