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A person with the smallpox disease is only contagious through spread of the fluids from the rashes or pustules A small circumscribed elevation of the skin containing pus and having an inflamed base. that develop as a result of the disease. Direct contact with infected skin can transmit the virus. However, the first locations lesions An abnormal change in structure of an organ or part due to injury or disease; especially one that is circumscribed and well defined. appear are typically inside the mouth. Therefore, coughing, sneezing, speaking and even breathing can spread the virus through saliva droplets expelled from the mouth. As a result, the greatest risk comes from prolonged face-to-face contact (6 feet or less, most often after 1 or more hours), with an infected person. This is particularly troubling for emergency workers because the patient may present with nothing more than a fever and sores inside their mouth that the emergency worker may or may not detect.