In a step meant to help prepare Wisconsin citizens respond to a bio-terror attack, the federal government recently approved Wisconsin’s smallpox preparation plan, which includes the administration of vaccinations to hospital response-team members beginning as soon as later this month.

“Each hospital has been asked to provide workers to volunteer to be vaccinated for smallpox in case a person came down with smallpox,” said Bruce Lindsay, assistant professor of emergency medicine at the University of Wisconsin and a doctor at the UW Hospital.

But with the long-term effects of smallpox vaccination still unknown, health-care providers’ unions have expressed concern over possible adverse reactions to the vaccination, and UW Hospital has been busy educating would-be volunteers on possible side effects before it begins formally asking for volunteers.

“We’re putting together our first line of defense, encompassing all areas of the hospital,” UW Hospital spokesperson Tim LeMonds said. “The first part of that plan is to get everybody on board.”

Lindsay said although the vaccine for smallpox is made using a weakened form of cowpox, which is very similar to smallpox, people who receive the vaccine come down with a mild case of cowpox.

“Once you get the injection, a little pustule usually forms on the shoulder. That’s how you know the vaccine is working,” Lindsay said. “In some cases, the infection can spread to the whole shoulder, the whole body. It can become a full blown case of cowpox, which can lead to encephalitis and death.”

The Center for Disease Control has estimated one in three people vaccinated would develop a fever severe enough to make them miss work, said LeMonds, who has heard estimates that people taking the vaccination have less than a one-in-a-million chance of dying from it.

LeMonds said many of the would-be volunteers were vaccinated against smallpox in childhood and that these people have even less of a risk of developing adverse reactions.

“We’re seeing a group of volunteers around the age of 32 to 35 who had the vaccination as children before smallpox was supposedly eradicated and they stopped vaccinating for it. If they didn’t have a reaction the first time, they probably won’t the second time,” said LeMonds, who also said he had known people who voluntarily received the vaccine while undergoing medical training in the military.

If the plan were to go forward, Le Monds said UW Hospital would need about 80 volunteers from all levels of staffing. Already 30 to 40 members of his staff have expressed interest in joining the response team even though the hospital has not started to actively recruit for it.

“Of course, there’s a risk to the health-care provider, but I think volunteers will step forward despite the adverse reactions,” said Lindsay, who shrugs off the possibility that working around vaccines could prove detrimental to his own health.

“Working in emergency medicine, I regularly deal with patients who have infectious diseases. Right now I have a patient who has a drug-resistant form of tuberculosis,” Lindsay said.

Despite thorough preparation on the part of UW hospital, Lindsay reiterated the threat of a bio-terror attack remains low, since the only known strains of smallpox in the world exist in governmental laboratories in Atlanta and Moscow. However, the Sept. 11, 2001, attacks raised concern among the Federal Bureau of Investigation that terrorist cells might focus their efforts on obtaining smallpox or other biological weapons on the black market to use the highly contagious virus on United States civilians or military troops.

One of the instances uncovered by the F.B.I. sparking concern is movement of a Russian infectious disease expert shortly after smallpox was irradiated in 1972, at the height of the Cold War. The scientist reportedly had access to smallpox on several occasions and then immediately traveled to Iraq, a country suspected to have a terrorist agenda against the United States.

“Once you’ve been exposed to smallpox, if you receive the vaccine in the first three to four days, it dramatically decreases your chances of coming down with smallpox or getting a serious case,” Lindsay said.

Lindsay said in the extremely unlikely event of a confirmed case of smallpox appearing, everyone who has come in contact with the infected person should be vaccinated within four days, which necessitates response teams.