The D.C. Health Department is scheduled to deliver a plan to the Centers for Disease Control and Prevention on Monday that proposes offering smallpox vaccinations to the District's entire population within a year.

     Like plans in other cities and states, the District's vaccination program raises the possibility that smallpox vaccine will be offered to the entire U.S. population under a policy President Bush is expected to announce in about a week.
     The policy is intended to counter the risk of terrorists unleashing the smallpox virus on the United States. Smallpox is one of the world's most lethal viruses. It is characterized by rash and high fever.
     District health officials are coordinating their plan with similar vaccination plans by the Maryland and Virginia health departments.
     The only undetermined issues are when the vaccinations would begin and how many people would receive them, said Dr. Michael Richardson, senior deputy director of the D.C. Health Department.
     "It's a foregone conclusion we are going to vaccinate people," Dr. Richardson said. "We expect this is going to occur."
     Pregnant women, children under 1, persons with eczema and anyone with a weakened immune system, such as those infected with HIV or chemotherapy patients, would be advised against getting the vaccinations.
     "They have a higher likelihood of an adverse reaction," Dr. Richardson said.
     Adverse reactions can include fatigue, body pains and itchiness. For every 1 million people vaccinated, one or two are expected to die. Between 14 and 52 others would suffer serious side effects, such as brain inflammation, according to the CDC's historical data on smallpox vaccinations.
     The emergency version of the District's plan lays the groundwork for all eligible D.C. residents and visitors to be vaccinated within one week after the first smallpox case is reported or by early 2004 if no cases occur.
     The vaccinations for health care workers could start as soon as this month under the "pre-event smallpox vaccination plan," Dr. Richardson said. Vaccinations for the general population, which would be administered at university auditoriums, would begin in about a year and continue for as long as 120 days, he said.
     Participating universities listed in the Health Department plan include American University, Catholic University, Gallaudet University, George Washington University and Howard University. Secondary school auditoriums might be used if they are needed, Dr. Richardson said.
     The U.S. Department of Health and Human Services is requiring the plans from all states and major cities to prepare for a bioterrorist attack.
     "The CDC has asked us to prepare plans about how to vaccinate the entire population in case a mass vaccination was determined to be necessary," said Trina Lee, spokeswoman for the Virginia Department of Health.
     The Virginia plan does not specify locations for administering the vaccine. Instead, it leaves the decision to the state's 35 health district directors, who would first consult local officials.
     Maryland health officials cited security concerns in refusing to say where vaccines would be administered.
     The Maryland plan focuses on first administering vaccines to hospital personnel and public health workers, which would require 6,000 to 8,000 doses, said Karen Black, spokeswoman for the Maryland Department of Health and Mental Hygiene.
     "We expect to have six to 10 sites to vaccinate the public health teams," Miss Black said.
     President Bush's announcement will determine the extent of the vaccination program.
     "The president has not made his decision," said Gordon Johndroe, spokesman for the new Department of Homeland Security.
     So far, the Bush administration's policy consists of "just preparation," he said.
     In the District and the nation, the vaccine would be administered in three phases. The first phase would be limited to hospital health care personnel and public health workers. It would include about 3,000 to 5,000 persons in the District.
     The second phase would be expanded to all emergency response personnel, which would be 50,000 to 100,000 firefighters, police, emergency medical personnel and other emergency workers in the District.
     The third phase would cover the general population, which Dr. Richardson said would be about 600,000 residents and visitors to Washington.
     The workers in the first two phases would receive the vaccinations at their job sites or public health clinics. The general population would get them at the university auditoriums.
     The emergency version of the plan, which the D.C. Health Department delivered to the Centers for Disease Control on Dec. 2, is essentially the same as the yearlong plan, except more personnel would be working in less time.
     Emergency management workers would give out food and water at the sites, mental health workers would stand ready for emotional outbursts, and security workers would keep order. The federal government would cover the costs.
     Another event that would trigger an accelerated vaccination schedule is war with Iraq.
     "The estimation of risks and threats changes at that point," Dr. Richardson said. "We may need to step up our preventive strategy."
     If no emergency occurs, the first phase of vaccinations for Washington is scheduled to be completed in 45 to 60 days, followed by phase two in 60 to 90 days, then phase three in 90 to 120 days. No starting date has been set for any of the phases.