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Smallpox is caused by the variola virus and results in a high fever and rash. It is contagious and sometimes fatal. While the disease was eradicated worldwide in 1980, the federal government has been focusing on smallpox response plans in the event of a possible terrorist attack.

In turn, the state has been working with hospitals, the military and tribal health officials, Pearson said. The state planned to submit its vaccination plan to the U.S. Centers for Disease Control and Prevention by today's deadline, she said.

The vaccinations would be voluntary and the plan would be implemented in phases, she said. State medical epidemiologists, public health nurses and hospital response teams would be first. Beyond that, what groups would be vaccinated next and when would depend on President George W. Bush's guidance, she said.

Vaccinations could begin in January, she said.

"We're expecting sometime this week the president will announce what the timetable will be and then our plan will be implemented accordingly," she said.

Earlier this month, the state submitted another plan detailing what would happen if a case of smallpox was identified and linked to a terrorist event, Pearson said. In general, it includes instructions on how to vaccinate every Alaskan within 10 days, she said.

"It's basically making sure teams of health professionals were trained and knew what to do," she said, "to arrange logistics and how the actual vaccinations would be administered."

No state has the laboratory capacity to identify the smallpox virus, and if a suspicious case appeared, samples would be sent to the CDC, said Dr. Beth Funk, a state medical epidemiologist with the Division of Public Health.

"What labs are being encouraged to do is check for the chicken pox virus first and rule that out," she said. "If it's negative and you have a highly suspicious case, you would contact the CDC, take specimens and send them to them."

People who received the smallpox vaccine in the past would need to get it again, Funk said. Immunity begins to wane in three to five years.

Unlike many vaccinations, the smallpox vaccine isn't a shot and isn't given with a hypodermic needle. Instead, a two-pronged needle is dipped into the vaccine solution and used to prick the skin, usually on the upper arm, 15 times in a few seconds, according to the CDC.

If the vaccine is successful, a red bump appears after three or four days. After one week, a blister forms that later turns into a scab, and then a scar. The vaccine is made from another "pox"-type virus, but doesn't contain the smallpox virus, according to the CDC.

Smallpox spreads from one person to another through prolonged face-to-face contact, through direct contact with infected bodily fluids or through contaminated bedding and clothing. The last case of smallpox was in 1977 in Somalia. In the United States, the last case was in 1949 and routine public vaccinations against smallpox stopped in 1972, according to the CDC.

Education, both for health professions and the public, will be one part of the state's plan, Pearson said.

"Part of what we need to work on over next few months is educating people about what smallpox is and what the vaccine is," she said.

• Joanna Markell can be reached at joannam@juneauempire.com.