Isolated hospital wards would have to be set aside for smallpox victims and those suffering complications, and to quarantine those who refuse vaccinations.

It is assumed that they might be more hesitant to refuse vaccinations for their children if paralysis from polio was still common.

(That is what happened in an unusual case last year in an Amish community in Minnesota where some had refused vaccinations.)

Some members refused vaccinations for their children.

One might as well refuse vaccinations for one's children on the theory that some deaths are caused by the shots.

In the past decade, the number of parents who refuse vaccinations of any kind for their children has more than doubled.

James Flateau, a spokesman for the Department of Correctional Services, said yesterday that 12 inmates at Downstate state prison who refused vaccinations have been kept in isolation "for about a week.

(The outbreaks in Africa and Asia began after many Nigerians refused vaccinations in 2003, suspecting they were a Western plot to sterilize Muslim girls.)

Workers should also not be subject to repercussions at their jobs if they refuse vaccinations.

Dr. Flanagan-Klygis said she had accepted families that had been turned away from other doctors because they had refused vaccinations.