The county expects to receive its first doses of smallpox vaccine by late January and will distribute them to as many as 400 front-line emergency workers, Public Health Director Marta McKenzie said.

As many as 6,000 other north state health care and emergency personnel could get the vaccine later next year, while the public will likely be able to get smallpox shots in 2004, McKenzie said.

The smallpox precautions are part of an enormous undertaking to prepare for bioterrorism, health officials said.

"I don't think we'll ever be totally ready as a nation," county Public Health Officer Andrew Deckert said. "There's all kinds of unexpected things that can happen. There's been many new diseases over the past 20 years. . . . We have a huge task ahead of us and it's going to be a continuous improvement process."

President Bush recently announced a plan to vaccinate more than 10 million health care and emergency workers nationwide on a voluntary basis for smallpox. Vaccinations of about 500,000 military personnel have begun.

The first civilians to take the vaccine will be those who work in hospital emergency rooms and on smallpox response teams. Shasta County will have two such response teams that will include nurses, epidemiologists, interpreters and mental health specialists, McKenzie said.

Next up will be other health care workers as well as police officers, sheriff's deputies, firefighters and emergency medical technicians. That group, which could number between 3,000 and 6,000 in Shasta County and 10 million nationwide, will be vaccinated "fairly soon after" the front-line responders, McKenzie said.

The third phase would be the public. Widespread public inoculations likely would not occur until 2004 largely because it will take that long to produce enough new vaccine, McKenzie said.

Public Health has received calls from residents curious about the vaccinations, she said.

"It's becoming more common dialogue as we're seeing it more in the press and in the news," McKenzie said.

Some of the nation's leading medical organizations complained last week that the government's program could strain already overburdened public health and emergency medical systems. The organizations are not convinced the threat of an attack with the smallpox virus is great enough to merit the substantial use of public health resources or the vaccine's risks to medical personnel.

Among the California Medical Association's 35,000 member physicians, those who work in emergency rooms or otherwise offer front-line care are more likely to think the vaccinations make sense, said Steve Thompson, the CMA's vice president of government affairs in Sacramento.

But other doctors are skeptical, Thompson said.

"There's a lot of physicians that kind of view the whole smallpox vaccine enterprise with a jaundiced eye, simply because there hasn't been a single recorded case of smallpox anywhere in the world," he said.

Officials for Redding Medical Center and Mercy Medical Center in Redding said they're prepared to cooperate with the county Department of Public Health to implement the plan.

The smallpox vaccine was distributed routinely to children until 1972. While the last case of smallpox in the United States occurred in 1949, the last case in the world was seen in Somalia in 1977. There were as many as 15 million cases worldwide only a decade earlier, Deckert said.

While smallpox has been eradicated as a naturally occurring disease, the Soviet Union's huge stockpile of biological weapons included as many as 100 tons of smallpox that could be distributed to large areas by missile, Deckert said.

Iraq admitted in 1995 that it had a bioweapons program since 1988, Deckert said. With a U.S. invasion of Iraq possibly near, it's been widely speculated that Iraqi leader Saddam Hussein would retaliate by sending smallpox to the United States.

"We don't know how much of a threat there is, but we know there's some," Deckert said. "If (smallpox) did come back, it would be a crime against humanity. But there are crazy people, and bioweapons have been used in the United States and abroad."

Smallpox kills one in every three people infected, and survivors could suffer blindness, scarring of the face or other maladies, Deckert said. It can spread from person to person fairly rapidly, most typically through close household contacts, he said.

In contrast, the smallpox vaccine can kill one in every 1 million users, Deckert said. The most serious complications include encephalitis and progressive vaccina, in which the vaccination site does not heal and the virus spreads.

The vaccine poses significant risks for certain people, including cancer patients, organ transplant recipients, people with HIV and pregnant women.

Nonetheless, the vaccine is one of only two ways to control the spread of smallpox; the other is isolation of patients and quarantine of contacts, Deckert said.

"You have to use those tools together," he said.

The nation's vaccination plan presumes there would be no confirmed cases before all the health workers get their vaccines. If a case were confirmed, the nation would go into a "post-smallpox case plan" all the states had to submit to the Centers for Disease Control and Prevention in Atlanta on Dec. 1, Deckert said.

If an outbreak were to occur, health workers would likely concentrate some of the roughly 12 million doses in the national stockpile on a given area, Deckert said. The vaccine can also be diluted, enabling it to treat more patients, and still be effective, he said.

"The nice thing about the smallpox vaccine is that . . . after exposure to the smallpox disease, you have four to eight days after exposure of smallpox disease to get the vaccine," Deckert said.

Until smallpox arrives — if it ever arrives — health officials in Shasta County and elsewhere will continue their preparations.

"I can assure you that public health staff has been working many long hours . . . to reduce the impact in the community" from bioterrorism, Deckert said. "Can we ever prevent every single death? No. Can we work hard to reduce the impact? Yes, and that's exactly what's happening."

Reporter Tim Hearden can be reached at 225-8224 or at thearden@redding.com.