In Amish country, nurses go door to door to stop deadly spread of measles

For the past few months, nurse Dale Weiser has been making unexpected home visits.

As the state battles the deadliest measles outbreak in recent history, the clinical supervisor drives 30 miles (48.3km), sometimes daily, to a rural corner of Pennsylvania where many Amish people live.

Walking into strangers' homes, Weiser says she tries her best to be respectful and non-intrusive as she vaccinates dozens of family members against the measles, sometimes around the kitchen table.

"A lot of people that I encounter, they don't have health insurance. They don't have a lot of interaction with the health system, and they just haven't seen the need to get these vaccines," said Weiser, who works for the Chester County Health Department.

"When you start talking and you answer their questions, and build that trust, a lot of times they will make a different decision."

The at-home vaccinations are part of the county and state health departments' strategy to encourage immunisations in the county, which includes an Amish community who abstain from many aspects of modern life, including regular contact with the western medical system.

The state health department told the BBC it has administered nearly 4,300 measles, mumps and rubella (MMR) vaccines at pop-up clinics near the epicentre of the outbreak since it began in late April.

But even as health officials see success in their vaccine programmes, the state has reported four deaths from measles complications, marking the most deadly outbreak the US has seen since 1992.