Hospital workers who will be the first to be vaccinated against smallpox are worried about the side effects and are pushing public health officials to offer more safeguards against the risks.

Even so, very few if any of the thousands of affected emergency room staffers in South Florida would refuse to be vaccinated despite the risk of getting sick, based on informal surveys by a union at two hospitals.

"I can't think of anyone who said no," said Mike Dellavecchia, an emergency room nurse who made a survey at St. Mary's Medical Center in West Palm Beach. "We're just worried whether there are proper safeguards in place. We just want to be sure we don't have unnecessary risk."

States were due to submit plans today to the U.S. Centers for Disease Control and Prevention about how they would immunize about 500,000 health workers who would deal with victims of a smallpox attack by terrorists.

President Bush is expected to soon order voluntary vaccinations for those 500,000, plus a like number in the military. A second wave of 10 million firefighters, police and other volunteers would be inoculated in the future. Bush has not decided whether to offer vaccine to the entire nation.

The decision is not simple, because the smallpox vaccine is one of the riskiest known. Before the nation stopped giving it in 1972, the vaccine caused one or two deaths, 40 serious illnesses and 1,000 mild illnesses per one million shots given.

At highest risk are people with HIV, cancer patients taking drugs that weaken the immune system, pregnant women and those with skin conditions such as eczema -- 30 million to 50 million in all. The vaccine also poses a risk for the families and patients of those vaccinated, because secretions from the scab can infect close contacts.

With so many at risk, the Service Employees International Union representing health workers said those being vaccinated should be educated about the vaccine, tested for the conditions that put them at risk, and excluded from vaccinations if they are at high risk.

Nursing officials contacted at three other hospitals in the region said that a high number of their ER staffs would be willing to be immunized.

Broward County's plan asks to vaccinate 3,600 health workers, including 150 to 200 at each hospital plus public health staff, said Dr. Tammy Blankenship, who oversees bioterrorism issues at the Broward County Health Department. The Miami-Dade and Palm Beach County plans are similar but exact numbers were not available.

Bob LaMendola can be reached at blamendola@sun-sentinel.com or 954-356-4526.