Sometime early next year, Judy Rudell expects to be vaccinated for smallpox, knowing the vaccine could make her sick, but convinced that it's the right move.

"There are some things you can worry about and some things you can't worry about, and this is one of those things you just can't worry about," said Rudell, 51, whose nursing agency routinely places her in the emergency rooms at Good Samaritan and Union Memorial hospitals.

Rudell is one of 6,000 health care workers in Maryland who would come into contact with the first victims of a biological attack and who will be vaccinated for smallpox as part of a federal plan to prepare for a terrorist-related outbreak of a disease eradicated in 1980. The vaccinations could begin as early as next month.

President Bush yesterday ordered members of the military serving in high-risk areas to be vaccinated for smallpox and said the vaccine will be made available to 450,000 civilian health care workers nationwide.

He said that health and national security experts do not believe vaccinations are necessary for the public and that his family is not being vaccinated, but he will be.

"As commander in chief, I do not believe I can ask others to accept this risk unless I am willing to do the same," Bush said.

Federal officials fear that the disease could be used in a terrorist attack. Several nations, including Iraq, are believed to have stocks of the virus.

Maryland's 6,000 vaccinated workers will include doctors and nurses who work in hospital emergency rooms and intensive care units, as well as some dietary and laundry workers, said Arlene H. Stephenson, acting secretary of the state Department of Health and Mental Hygiene.

Federal authorities told state health directors in a conference call Thursday night that the Centers for Disease Control and Prevention has shipped smallpox vaccine supplies to a variety of undisclosed locations around the United States.

The U.S. Department of Health and Human Services is requiring states to comply with a three-step vaccination plan to be implemented after the Homeland Security Bill - protecting the vaccine's manufacturer from liability - takes effect Jan. 24, Stephenson said.

The 6,000 hospital and local health department workers are to be vaccinated voluntarily within 30 days of receipt of the vaccine, which will be shipped at dates to be determined by federal authorities, she said.

She said the plan's second phase calls for vaccinations of police, firefighters and paramedics who would respond to any outbreak. That phase would take 45 days, she said. A final phase of the plan, expected to begin next spring, will allow for public vaccinations, she said.

David Daigle, a CDC spokesman, said that people who want the vaccine, which was developed in the 1950s, will be able to get an unlicensed version by next spring available through a clinical trial process. A licensed vaccine should be available by the spring of 2004, Daigle said.

Dr. Peter L. Beilenson, city health officer, said the plan calls for vaccinations of 1,828 health workers in the city overall, working at 12 city hospitals. Baltimore County health officials say 665 workers will be vaccinated, including 635 at four county hospitals.

Beilenson added that deadlines imposed by federal officials are unrealistic because of the difficulties in vaccinating so many people.

"Everybody who deals in the real world is saying it's not possible," Beilenson said.

Stephenson said that she plans to meet with health experts and hospitals sometime next week to review their screening process and minimize the risks that those vaccinated become ill or die.

Of every 1 million people vaccinated, one or two will die and up to 50 will become seriously ill, according to the CDC.

Those at risk include infants under 1 year old, people with skin conditions such as eczema and those with immune systems weakened by cancer treatments, organ transplants, kidney failure or HIV, according to the CDC. The agency also recommends that pregnant women not be vaccinated.

Those vaccinated will be given patches to cover lesions left by the injections, but experts say the patches are not foolproof and the virus used in the vaccine may be shed from the skin and spread to others.

"The patches aren't 100 percent foolproof," said Dr. Harold Standiford, director of infection control at the University of Maryland Medical Center.

Standiford and other experts say they are unsure if those vaccinated might infect at-risk patients with skin conditions and weakened immune systems.

But the CDC recommends that those who live with someone at risk should not be vaccinated unless they are exposed to the disease.

Stephenson said that hospitals must decide whether vaccinated employees should be given time off or assigned duties where they will not be exposed to at-risk patients.

"There's a lot of details that have to be worked out," said Dennis Schrader, vice president for project planning at the University of Maryland Medical System.

Schrader said that it is unlikely that vaccinated workers will be given days off. He said it's more likely they will be assigned to other areas.

Routine vaccination for smallpox stopped in 1972 after the disease was eradicated in the United States, according to the CDC.

Health experts also are unsure if those over the age of 34 who were vaccinated decades ago are still protected from the disease, but most agree that they are less likely to experience side effects than those vaccinated for the first time. Side effects include a fever and swollen lymph nodes.

Rudell said that's one reason she's not worried. She has been vaccinated twice, once in Baltimore when she started school and once in Virginia, where she moved as a child.

Standiford said that he also expects few complications when he is vaccinated with much of the hospital's emergency medicine and infectious disease staff.

"I feel fine about it because I've been vaccinated before," said Standiford, who is 64.

David Murphy, a Baltimore County paramedic and a supervisor at the county's Brooklandville fire station, also concluded that there is little risk in a second vaccination after he discussed it with department experts and reviewed health-related Web sites.

He said that up to 900 paramedics and firefighters will have to decide the same question in the months ahead.

"There is some anxiety out there, because there is some risk, but overall I think it's worth it," said Murphy, 47.

The Associated Press contributed to this article.