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The researchers exposed the cells to vaccinia virus, a relative of the smallpox virus used since the 18th century as a smallpox vaccine. The degree to which the immune system cells responded to the virus offers a rough indication of immunity, the researchers said. The researchers said the participants could not recall how many times they had been vaccinated. Four of the participants in the North Carolina study had last received smallpox vaccinations within five years according to federal guidelines because they worked with the vaccination virus. Nine others were vaccinated from 6 to 35 years earlier. The researchers said the samples from all 13 vaccinated participants showed a robust immune response. Another author of the textbook, Dr. D. A. Henderson, who led the health organization's smallpox eradication effort and who is now a top government adviser on bioterrorism, said he had ''no idea'' how the new findings correlated with protection against natural exposure to smallpox. Dr. Henderson said it was ''perfectly obvious that one successful vaccination does not protect for a lifetime.''

The researchers exposed the cells to vaccinia virus, a relative of the smallpox virus used since the 18th century as a smallpox vaccine. The degree of the immune system cells' response to the virus offers a rough indication of immunity, the researchers said. The researchers said the participants could not recall how many times they had been vaccinated. Four study participants had last received smallpox vaccinations within five years, according to federal guidelines because they worked with the vaccination virus. Nine others were vaccinated from six to 35 years earlier. The researchers said the samples from all 13 vaccinated participants showed a robust immune response

The steps include opening new laboratories; improving the ability to detect microbiological and chemical agents; monitoring emergency rooms for certain ailments; adding more antibiotics and vaccines to the emergency stockpile; educating health care professionals; and teaching the newest epidemiologists how to quickly respond to an emergency. At a news conference yesterday, the director of the centers, Dr. Julie L. Gerberding, and other top officials said they had made it a priority to upgrade the agency's emergency operations center. This and other changes stemmed from consultations with experts on how to improve the agency's response in the event of another bioterrorist attack. To evaluate the speed of the health system's response to an outbreak, the agency is analyzing the time between the ordering of a blood test by a doctor who suspects that a patient is infected with the West Nile virus and the confirmation of the diagnosis by a state or local health department. The disease control agency is relying on state laboratories to report West Nile cases and is not confirming each case itself

Gro Harlem Brundtland said she would not run for re-election next year as director general of the World Health Organization. Dr

Smallpox vaccine can lead to serious and potentially fatal complications, especially in people with impaired immune systems. The virus from which the vaccine is derived, a cousin of the smallpox virus, can spread from recipients to people with whom they come in contact and can cause life-threatening complications among them. More disturbing were the data concerning risks among people with a common skin condition, eczema. People with it, or who have had it, are at higher risk of complications from the smallpox vaccine. The rate was one case of complications per 100,000 vaccinations, a figure that exceeds the risk of paralysis from the oral polio vaccine. The government stopped oral polio vaccinations because it considered the risk too high. ''Unless it's an emergency where we may need to vaccinate everyone within a couple days, we need to go slow in the initial rollout, work out the kinks and get some experience in giving the vaccine,'' Dr. [Marcelle Layton] said. The problems include who will have legal liability for adverse reactions and risks in administering the vaccine, which is considered the most dangerous of all immunizations. Training doctors and health workers how to administer the vaccine properly and recognize a successful smallpox vaccination reaction, known as a ''take,'' could also be a challenge. Last fall, when the C.D.C. vaccinated nearly 200 staff members as part of its smallpox response team, it canceled plans to vaccinate more in part because the doctors who performed the vaccinations became alarmed at the severity of the reactions and the accompanying fever, sore arms and swollen lymph nodes. The doctors prescribed antibiotics in the mistaken belief that some vaccination takes had become infected

More than two months after a national advisory panel recommended vaccinating thousands of health-care and emergency workers against smallpox as a precaution against a bioterrorist attack, state and local health officials are waiting for the government to announce its official policy. No vaccinations have taken place. Because the United States stopped routine smallpox vaccinations in 1972, tens of millions of younger Americans have never been vaccinated against a disease that can kill up to 30 percent of its victims. It is unclear how well protected those people, who received vaccinations decades ago, are

More than two months after a national advisory panel recommended vaccinating thousands of health care and emergency workers against smallpox as a precaution against a bioterrorist attack, state and local health officials are waiting for the government to announce its official policy. No vaccinations have taken place. On June 20, the panel unanimously rejected a proposal to offer vaccine to every American and recommended immunizing only about 15,000 'first responders' -- the health care and law enforcement workers who would be most likely to respond to a biological attack

No patient has entered the trial, which the F.D.A. allowed on Monday, said Dr. James Rahal, the chief of infectious diseases at New York Hospital Queens and a leader of the study. Dr. Rahal was one of the first American physicians to study West Nile virus in 1999, when the illness, which is carried by mosquitoes, was first detected in this hemisphere

The strain of West Nile virus spreading in the United States is identical to one that infected geese and humans in Israel, but no one knows how it came here. Large numbers of bird deaths from West Nile disease have occurred concurrently with human cases only in Israel and the United States, said Dr. Lyle R. Petersen, an epidemiologist who specializes in studying insect-borne infections at the Centers for Disease Control and Prevention

Already, West Nile has provided some useful, and sometimes painful, information. Most disturbing is the virus' changing face. The frequency of human outbreaks in Europe, the Middle East and this country has risen over the last decade. So, apparently, has the severity of human disease. Also, at 55, the median age of West Nile encephalitis cases in this country this year seems to be a decade lower than in earlier outbreaks. The strain of West Nile virus spreading in the United States is identical to one that infected geese and humans in Israel, but no one knows how it came here. Large numbers of bird deaths from West Nile disease have occurred concurrently with human cases only in Israel and the United States, said Dr. Lyle R. Petersen, an epidemiologist who specializes in studying insect-borne infections at the Centers for Disease Control and Prevention. Israeli doctors reported the first epidemics in 1951. A large outbreak of an illness in the region in 1941 may have been West Nile fever, but documentation is lacking because diagnostic tests were not available. Later outbreaks in Israel involved nursing home patients and soldiers, but West Nile was nearly forgotten there by the end of the 20th century