With 15 pinpricks to his left shoulder, Dr. Mark Horton on Thursday moved to the head of Orange County's line of defense against bioterrorism.
The county's top medical officer became the first local health worker to be vaccinated against smallpox as part of a nationwide program aimed at preparing "first responders" if the virus is unleashed in a terrorist attack.
Three other county health officials -- Linda Malchow, Sally Wurth and Margaret Beed -- followed Horton in rolling up their sleeves for inoculations at the Health Care Agency offices in Santa Ana. Horton said he hopes more people in the medical community come forward for inoculation.
But few in the county agency and those who would be next in line for vaccinations -- hospital and clinic workers -- have volunteered, citing the risk of possible side effects, such as encephalitis, severe skin infections and fever.
While individual health workers struggle with whether to volunteer, hospitals are wrestling with questions of liability if an employee becomes ill.
South Coast Medical Center in Laguna Beach has opted out of the program entirely.
Initially, 200 of the 1,100 eligible county health employees volunteered late last year, Horton said.
But, over the next few weeks, they and only 34 more public health nurses, environmental health specialists and epidemiologists are expected to receive one of the 500 doses of smallpox vaccine sent to the county by Sacramento.
"We realized that some would have to go home to think about it," Horton said.
Vaccinations provide protection for up to 10 years, he said.
Should the virus, eradicated around the globe in the late 1970s, be reintroduced, county officials said they are prepared -- to a point.
"If one or two cases [of smallpox] show up, we should be ready," Horton said. "If 100 cases show up, we would be crying for help."
The U.S. Centers for Disease Control has sent California about 10,000 doses of the vaccine. As of last week, 481 have been administered across the state and nearly 17,000 around the nation, according to the CDC. The agency reported 15 cases in which side effects surfaced, but none have been life-threatening.