By Maggie Downs
The Cincinnati Enquirer

Leann Morgan, 8, a second-grader at Elmwood Place Elementary School demonstrates how to wash her hands according to the Germ Buster poster behind her. (Jeff Swinger photo illustration) | ZOOM |

Callers to St. Bernadette School in Amelia heard what is now a familiar refrain across the Tristate.

"We are closed Tuesday, Feb. 4, and Wednesday, Feb. 5, due to illness in our student body," the recorded message said. Tuesday marked another bad day in what many educators and parents are calling the worst bout of student illness in recent memory.

At least 17 schools were closed Tuesday, and many are closed today. Tristate pediatricians say the cause is a soup of winter bugs.

Some have fevers, runny noses and coughs from common colds and bronchitis. Some have strep throat, which causes fevers and sore throats but not so much coughing. Some have true influenza or other influenza-like viral infections. Some have gastrointestinal illnesses that cause vomiting and diarrhea.

All of these illnesses are common in winter months.

"The problem is they all seem to be peaking at about the same time," said Dr. Steve Muething, associate director of general pediatrics at Cincinnati Children's Hospital Medical Center. "We noticed things starting to pick up about two weeks ago, but it hasn't started to wear off yet. I don't know when it will break."

Even so, the emergency room at Children's has yet to record the peak numbers reached in recent years.

At St. Jude School in Bridgetown, 128 of 501 students called in sick Monday, with 30 sent home later, prompting the school to close Tuesday and today.

"We've had some sickness before, but nothing like what we went through," said principal Jay McNitt. "The nurse's office was like a MASH unit."

WINTER ILLNESSES

Colds: Minor viral infections of the nose and throat caused by five families of viruses that include hundreds of different strains. Symptoms start with scratchy or sore throats with gradually increasing nasal congestion, runny nose and sneezing. Mild fevers are possible. Influenza: Acute viral infection of the respiratory tract, including the nose, throat, lungs and middle ear. Symptoms include headache, fever, a dry cough, chills, muscle aches and joint pain. Strep throat: A sore throat, headache and fever caused by bacterial infection. The throat becomes beefy red. Tonsil swelling, nausea and vomiting can occur. Coughing and stuffy nose are not common. Can be treated with antibiotics. Bronchitis: An inflammation of the bronchial passages that can be caused by viral or bacterial infection. Often starts with cold-like symptoms with a cough that can include increasing amounts of white, yellow or green sputum. A fever can last 3 to 5 days; the cough for weeks. Gastrointestinal illness: Vomiting and diarrhea that can be caused by bacterial, viral or parasitic infections. Rotavirus is a common cause of childhood gastrointestinal illness. RSV: Respiratory syncytial virus infects the lungs, triggering a sore throat and runny nose then progressing into coughing, wheezing and breathing difficulties. Can be a life-threatening illness for infants, but causes milder cold-like illness in older children. Brochiolitis: A sudden difficulty in breathing marked by a hacking cough and rapid heart rate. Can include a fever and vomiting. Usually seen in children under 18 months. Caused by several viruses. Pneumonia: A potentially life-threatening lung infection that can be caused by many viruses and bacteria. Symptoms include chills, fever, a cough that produces sputum, chest pain and shortness of breath. Bacterial causes can be treated with antibiotics, but some strains are resistant. Source: Merck Manual of Medical Information

McNitt suspects the virus was spread at a lock-down dance (students must stay until the end) about two weekends ago. The event involved many west-side Catholic schools, which were among the hardest hit Tuesday.

"I heard a lot of sick kids who shouldn't have been there showed up," he said.

At St. Catharine School in Westwood, Sylvia Ambrosius has seen most of the sick children personally. Since the school's nurse works part time, the school secretary has been taking on the extra work.

"That's all I've been doing is taking care of the kids and calling their parents to take them home," she said.

To prevent the virus from spreading further, Ambrosius has passed out hand sanitizer and disinfectant to teachers.

"We need masks out here," she said.

In his four years as Glen Este Middle School principal, Kevin Thacker has never seen anything like this. Some 363 students - 34 percent of the student body - were out sick Tuesday. Seven of 65 teachers were also ill.

"(Monday) we had to bring another nurse from another building,'' he said. "We had them in the nurse's office. We had them in the lobby."

At the Dayton Independent School District in Kentucky, administrators hoped that closing Friday would allow enough time for germs to die over the weekend. They were wrong.

"We came back to school (Monday) and had even more out than we had out last week," said Patty Patterson, director of student services.

Closing schools for illness is not an easy decision, said Roger VonStrohe, director of pupil personnel for Newport Independent Schools.

"It's a constant struggle in weighing what's best for the kids, the community and the parents," he said. "Working parents have to find baby sitters. It is disruptive to the community."

Another factor that weighs on Kentucky superintendents is funding, he said. That may explain why Kentucky public schools are more likely to close for illness than Ohio's.

"We have something called ADA - average daily attendance," VonStrohe said. "When students are out, it cuts down on the amount of funding you get from the state. It's financially advantageous to close if you have a districtwide attendance problem. In Ohio, their funding is based on membership (enrollment). They get the same amount of money whether the kids show up or not."

In Hamilton, however, St. Ann's School canceled classes today through Friday because so many students, teachers and staff are out ill, said principal Donna Weber.

"We're going to bite the bullet and close," Weber said.

Even if she could find enough substitute teachers and staff, Weber questioned how much instruction would take place when so many students were absent.

Doctors say the school closures can make a difference.

"Getting kids away from each other for three or four days does help decrease the spread of illness," Dr. Muething said.

However, there are no clear standards from the public health community over when a school should be closed, Dr. Muething said.

Day-are centers, for example, are required to send children home when they have fevers or diarrhea. But schools are not as heavily regulated and are less likely to detect a student with a fever, Dr. Muething said.

Complicating the situation, some working parents make illness outbreaks worse by knowingly sending mildly ill children to school.

"A lot of parents are under a lot of pressure not to miss work and may not have anybody else to take care of them," said Dr. Elmer Martin, a pediatrician with Group Health Associates. "So they feel obligated to send children to school."

Some parents truly are feeling the brunt of the sick wave, like Tracy Epure, 35, a mother of two from Colerain Township.

"Every Friday for three weeks I've been out taking care of sick children. It puts working mothers in a real bind," she said.

"I've cleaned everything in the house. I've disinfected all their school supplies. I've even boiled the toothbrushes," she said. "They should close all schools for one week to let this run its course. What's one day going to do?"

Other parents are equally frustrated.

"For the past week and a half, I have made at least nine different trips to Kroger to buy cold medicine, Puffs, orange juice and Popsicles," said Keli Butler, 32, of Landen, the mother of two sick boys.

"I finally joined Blockbuster's `Member Rewards' plan because I had rented so many DVDs over the weekend, it finally seemed worth it."

Tim Bonfield, Sue Kiesewetter and Cindy Kranz contributed to this report.

E-mail mdowns@enquirer.com