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The initial phases of the vaccination plan would cover about 500,000 military personnel and 500,000 civilians, mostly health care and emergency workers who would most likely be exposed if someone contracted smallpox, officials said. Eventually, as many as 10 million people in law enforcement, health care and emergency response could be offered the vaccine. Defense officials said troop vaccinations could start today. [C. Mack Sewell] and other experts said doctors need time to build up experience in administering the smallpox vaccine while avoiding danger. People at risk of complications include those whose immune systems have been weakened by cancer, AIDS or other diseases. The vaccine, made of a live virus closely related to smallpox, known as vaccinia, can cause death or injury in susceptible people. Such people could presumably decline to be vaccinated, but would remain vulnerable to infection with vaccinia virus shed by those who had taken the vaccine

Instead, Mr. [Bush] authorized a voluntary program to vaccinate about 450,000 doctors, nurses and emergency workers who would be the first to respond to any effort by terrorists or hostile nations to use smallpox as a weapon. The vaccinations are expected to be given from late January through March. In recent months, an advisory panel on immunization policy, many public health leaders and infectious disease experts have expressed deep concern that smallpox vaccination, the most dangerous human immunization, posed too great a risk for the public because no case of smallpox has occurred anywhere since 1980. Dr. E. Stephen Edwards, president of the American Academy of Pediatrics, urged the Bush administration to ''consider the devastating effects'' smallpox vaccinations could have on children. ''No trials have been conducted on children,'' who may have a higher incidence of injury from the vaccine than adults, Dr. Edwards said

A new smallpox vaccine will be provided free to Americans who want it if the vaccine, now being manufactured, passes licensing tests as expected in 2004, Tommy G. Thompson, the secretary of health and human services, said yesterday. As long as there are no smallpox cases, the vaccine is unlikely to be given to children, even if parents request it, because it has not been tested on them, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. Researchers had hoped to conduct such studies in children, but ethics panels at medical centers refused to allow them, citing federal regulations banning human experiments in which risks outweigh benefits, he said. Plans are still being worked out to provide vaccine for Americans who want it now. Dr. Fauci said that one way was for people to enroll in clinical trials being conducted to study smallpox vaccine

If a smallpox vaccine recipient inadvertently transmitted the virus in the vaccine to other people and they fell ill, who would pay for the sick people's medical care? The question arose over the weekend after President [Bush] announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to other people, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications

The question arose over the weekend after President Bush announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to others, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications. General recommendations are that people who have recently been vaccinated stay out of close contact with others or cover the vaccine site with a bandage, because the virus can be shed from the site for several weeks after inoculation. Some hospital officials say that newly vaccinated workers who take care of patients will be required to wear special semipermeable bandages at work, because they are better than gauze at containing the virus. If secretions from a smallpox vaccination soak into clothing or blankets, the vaccinia virus may survive in the fabric for a day or two and could theoretically infect someone else who comes into contact with the item, said Dr. Donald A. Henderson, the epidemiologist who led the global smallpox eradication program and who now is a senior science adviser to Mr. [Tommy G. Thompson]

There were no heart attacks or deaths among the 200 participants in the study, because they had implanted defibrillators, which monitor heart rhythms and deliver electric shocks to restore normal heartbeat when they detect life-threatening abnormalities. Two of the authors -- Dr. Jonathan S. Steinberg, chief of cardiology at St. Luke's-Roosevelt Hospital in Manhattan, and Dr. Marcin Kowalski, a resident at St. Luke's -- said the findings documented persistence of increased psychological stress after Sept. 11 and showed compelling evidence of its effects on the heart. The researchers scrutinized the electrocardiograms stored in the device for evidence of two life-threatening abnormal rhythms -- ventricular tachycardia and ventricular fibrillation. The device is programmed to deliver a shock when either of these rhythms develops. (The researchers did not study the rate of arrhythmias that were not life threatening.)

Under one possible scenario, the vaccine could simply be kept from the public until it is licensed, which is expected in 2004. Under another, people could apply for the vaccine under the 'investigational new drug' rules of the Food and Drug Administration. Under the new drug, or IND, rules, people who make a compelling case that they need experimental medicines can be given permission to take them by the FDA. But the process is cumbersome, and it is unclear how easily smallpox vaccine could be obtained if the president chose to make it available this way. Existing stockpiles of the vaccine, which are decades old and are not currently licensed by the government for use, will be kept for use only if there were an attack before the new vaccine was available. There is enough of the old vaccine on hand to inoculate all Americans, administration officials said. Smallpox vaccine is the most dangerous human immunization. Before the United States stopped routine smallpox vaccinations, life- threatening complications occurred at a rate of 15 per million among those who received their first smallpox vaccination, and the number included about one to two deaths

Since then, the vaccine has been given only to a few thousand qualified scientists who work with the smallpox virus and the vaccine, which is made from a closely related live virus, under top security precautions in approved laboratories. After eradication, the former Soviet Union and the United States were allowed to keep stores of the smallpox virus for research, one in Russia and one at the disease control agency in Atlanta. Original plans called for destroying the stores of the virus, but they have been deferred, largely because of disclosures that the former Soviet Union secretly weaponized smallpox virus. Smallpox vaccine is the most dangerous human immunization. Before the United States stopped routine smallpox vaccinations, life-threatening complications occurred at a rate of 15 per million among those who received their first smallpox vaccination, and the number included about one to two deaths

The initial phases of the vaccination plan would cover about 500,000 military personnel and 500,000 civilians, mostly health care and emergency workers who would most likely be exposed if someone contracted smallpox, officials said. Smallpox vaccination is complicated and dangerous because the virus in the vaccine can be transmitted inadvertently to other people, state and infectious disease experts said. [C. Mack Sewell] said New Mexico planned to immunize just 120 people in the first round, gradually expanding to about 12,000, a process that could take six to nine months. The state's plan, he added, had major uncertainties. 'As with everybody else, it remains to be seen how many people will volunteer for this,' Sewell said

Mr. [Tommy G. Thompson] oversees the Centers for Disease Control and Prevention in Atlanta, which has acknowledged its failure to prepare adequately to communicate during the anthrax outbreak. In the first days of the outbreak, C.D.C. did not take the leadership in providing vital medical and epidemiologic facts to state health departments, practicing physicians and the public. Spokesmen for the centers said the information was supposed to come from Mr. Thompson's office. Much of Friday's briefing centered on clarifying the options and what officials had recommended to Mr. Thompson and President Bush. But before reporters could question Dr. [Julie L. Gerberding] about this unexpected news development, she suddenly left the stage, leaving two participants, Jerome M. Hauer, an assistant secretary of health and human services and director of the department's Office of Public Health Preparedness, and Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, to field the questions. Also, reporters entering the auditorium at Mr. Thompson's headquarters on Friday afternoon passed packets about smallpox stacked on a table. The reporters were not allowed to take them until they were distributed after the news briefing began. So reporters were deprived of an opportunity to inform themselves before asking questions. But, as it turned out, the packets contained little new information and no summary of the messages the top officials were trying to make in the briefing