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State and local officials are prepared to start vaccinating between 5,000 and 10,000 Minnesotans within the next few weeks, under a plan submitted by MDH to federal officials in early December. The plan was developed in response to a request from the U.S. Centers for Disease Control and Prevention (CDC). All states were asked to submit vaccination plans.

MDH officials say the effort will focus on people who would be expected to play a key role in responding to an actual smallpox outbreak caused by an act of terrorism. That includes hospital personnel to care for smallpox patients, teams of professionals who could quickly vaccinate large numbers of people against smallpox, and public health workers who would investigate and respond to the outbreak.

Once vaccinations begin, the first phase of the plan is expected to take about 30 days to complete. Once that's done, it's anticipated that the vaccination effort will eventually be expanded to include a much larger group of people, including additional health care workers and public health personnel, emergency response workers, and personnel responsible for law enforcement and public safety. This second phase of the vaccination effort could involve as many as 200,000 people in Minnesota.

President Bush has also indicated that vaccinations will be offered to members of the public who ask to be vaccinated. However, both President Bush and public health officials have emphasized that vaccination will not be recommended for the general public - because there is no imminent threat of a smallpox attack, and because of the potentially significant health risks associated with the smallpox vaccine. MDH officials say they are waiting further guidance from CDC regarding the second phase of the vaccination effort, and the proposed mechanism for making the vaccine available to the general public.

The initial phase of the vaccination program is especially critical, officials said.

"The people we're considering for vaccination, during this initial phase, would have important jobs to do if we ever had to deal with an actual terrorist incident involving smallpox," said Dr. Harry Hull, Minnesota's State Epidemiologist.

"They are the people who would be caring for the sick, investigating the outbreak, and taking steps to control it. They are the people who would be coordinating our response to a bioterrorism attack, and maintaining public order."

"If we ever do experience an actual smallpox attack, many of these people could be exposed to the illness in the course of doing their jobs," Dr. Hull said. "But at that point, it may not be feasible for them to take time out so they can be vaccinated. They're going to have too much to do."

Groups that are being offered vaccination during phase one include: patient-care teams in hospitals that are equipped to handle smallpox patients; emergency medical personnel; other health care providers; infectious disease investigation teams; teams of people to administer the vaccine; other critical health personnel; and a limited number of emergency management, law enforcement, emergency response, and critical infrastructure personnel.

During phase one, only a limited number of people will be considered for vaccination in some of these groups. Many more of them will be included during phase two.

Under their plan, MDH staff and local public health personnel from around the state will be responsible for administering the vaccine during phase one.

In the event of an actual outbreak, most people would still have time to get vaccinated after the first cases of smallpox had already been reported. Only "emergency responders" - the people targeted by the first and second phases of the vaccination effort - would need to be vaccinated in advance.

Participation in any phase of the proposed vaccination effort is completely voluntary, and some people should never get the vaccine unless there's an actual smallpox attack, according to Dr. Hull. "Nobody will be required to get a smallpox vaccination," Hull said. "We also won't be vaccinating anyone who is at high risk of having a bad reaction to the vaccine."

The high-risk groups include: people who might be allergic to the vaccine; pregnant women and nursing mothers; people with medical conditions that could weaken the immune system; people taking medications or receiving medical treatment that could weaken the immune system; and people with certain types of skin conditions.

CDC currently controls available supplies of the smallpox vaccine. The states will be given enough vaccine to carry out their vaccination plans - which are now in the process of being approved by CDC.

Members of the public with questions about smallpox vaccinations can call 1-800-657-3903 on weekdays during normal business hours.

To see a copy of the state smallpox vaccination plan, go to www.health. state.mn.us/oep/planning/planresources.html.