| chaoseffect |
As the spell is fortitude negates doesn't mention additional saves for staying within the cloud (like for instance, Stinking Cloud, a similar spell), I'd say creatures would only need to save one time, period. That said, if it were my game I'd probably houserule it to function more like Stinking Cloud.
baradakas
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There is only one saving throw required to resist the effects of the spell. Standing in the cloud for multiple rounds (or having it envelope you on subsequent rounds) does not force additional saves.
The only extra saving throws would be any required for additional effects of the disease contracted after the initial failed save.
The major power of this spell is that failing a save causes the disease to be "contracted immediately as an immediate effect", as opposed to the normal onset period of diseases, which are measured in days. Laying a heavy boom on a target like that is quite strong, and forcing subsequent saves, while perhaps logical, would increase the "power level" of this spell.