To the Editor. Varicella infection poses a significant risk to individuals with chronic lung disease and those on immunosuppressive therapies. We report our experience of varicella exposure at a pediatric pulmonary summer camp. An 11-year-old boy with asthma developed classic chickenpox lesions on day three of camp. The camp staff was unaware of his exposure 2 weeks before camp. All campers and staff members had probable exposure to this camper. The camp consisted of 106 campers (<18 years) with asthma, cystic fibrosis (CF), other chronic lung diseases, and tracheostomies, some of which required chronic ventilation. Additionally, there were 96 staff members, of which several had CF and/or asthma, and a single staff member with idiopathic pulmonary hemosidersosis and 1 with a high cervical spine injury with a tracheostomy on chronic ventilation.Varicella is a common infection of childhood that is usually mild and self-limited. However, immunocompromised individuals are at increased risk for serious complications and death.1 Additionally, recent oral steroid use,23 inhaled corticosteroids,4 and nasal steroids5 has been associated with complicated varicella infections. It has previously been recommended that patients with CF should receive acyclovir if they develop varicella.6 We are not aware of any recommendations on the treatment of varicella exposure in tracheostomized individuals, with or without chronic ventilation, or those with other chronic lung diseases. Thus, criteria were established for our camp population considered at greatest risk from varicella infection, such that they would be recommended to receive varicella-zoster immune globulin (VZIG). The following criteria were adopted: no history of receiving the varicella vaccine or previously having chickenpox, and one of the following: 1) requiring immunosuppressive therapy secondary to a transplant or for disease management, 2) receiving >1000 μg daily of inhaled and/or nasal corticosteroids, 3) currently receiving oral steroids or has received steroids within the last 3 months at a dose >0.5 mg/kg/day, 4) pregnant,7 or 5) tracheostomized with chronic lung disease.Three individuals met the established criteria for VZIG: 1) a 17-year-old boy with CF status post a liver transplant, 2) a 14-year-old boy with cerebral palsy and mental retardation with a tracheostomy and chronic lung disease, and 3) a 23-year-old pregnant student nurse. The student nurse opted not to receive the VZIG. Additionally, we recommended that individuals with CF, or a tracheostomy and lung disease, or those on inhaled or nasal corticosteroids, and those >18 years of age should receive acyclovir if chickenpox were to develop. Five campers and two staff members developed chickenpox. Fortunately, there were no complicated courses.Our camp represented a relatively high-risk population that could have had complicated varicella infections. Guidelines for the care of such a group do not exist. The criteria we adopted were successful in our limited patient population, and can serve as guidelines for others facing similar circumstances.