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ATLANTA Dec. 18 —

Thirty years since the last routine smallpox vaccinations were given, state health officials are getting reintroduced to the scar-causing vaccine, double-pronged needles and safety measures they'll need to inoculate thousands against the infectious virus.

The Centers for Disease Control and Prevention this week began training hundreds of health officials from around the country to learn how to safely administer the smallpox vaccine.

Next month, the state officials and the people they train are expected to begin inoculating medical teams and others who would respond to a smallpox attack. If the public is threatened by a bioterrorist attack of the virus, the health workers will give them the vaccine as well.

Routine immunization for smallpox ended in 1972 in the United States, so in many cases, trainees who never had to give the inoculations were taught by CDC workers who themselves were trained in the procedure just last week.

Milly Noonan and Peggy Ware of the Kentucky Department of Public Health were among those Wednesday learning how to deliver the vaccine, using a double-pronged needle to prick the recipient's arm about 15 times.

Unlike traditional needles that inject a relatively large amount of vaccine directly into a vein, the double-pronged needle is used to deliver a drop of smallpox vaccine just under the skin. The vaccine leaves pustules that create a distinctive, dime-sized red scar on the arm.

"It really is not a painful process at all," said Noonan, who was vaccinated last month for a University of Kentucky study. But she was having trouble drawing blood from Ware in a mock inoculation that used saline solution instead of vaccine.

"You've got stiff skin," Noonan complained.

"You're just not sticking very hard," Ware replied.

About two dozen pricks later, Noonan finally drew a spot of blood.

The training is needed not just because of the inoculation method, but because smallpox shots involve a live vaccine that can spread to other people if not safely administered or contained, said Dr. Joanne Cono of the CDC.

Also, people with weakened immune systems need to be screened out, and those who are inoculated must receive follow-up to guard against side effects that in rare cases can be serious or even fatal.

For every million people who take the shot, about 1,000 will experience minor side effects such as a rash or sores. Between 14 and 52 people will have serious reactions such as serious skin rashes, skin infections or even brain inflammation. One or two people may die from reactions to the vaccine, according to the U.S. Department of Health and Human Services.

Noonan said she had some swelling where the shot was given and headaches about a week after getting the vaccine. "But I never missed a day of work."

The push to vaccinate health care workers has been fast-paced: On Nov. 22, the CDC gave state health departments two weeks to develop plans to deliver the vaccine.

Last week, President Bush announced the U.S. military would receive the vaccine. Bush also is getting inoculated, and said the vaccine would be offered to the general public within months, although he is not recommending it for most Americans.

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