Nurses in rural Pennsylvania are visiting Amish homes to provide measles vaccinations as the US faces its deadliest outbreak since 1992. The door-to-door effort aims to overcome limited access to healthcare, lack of insurance and mistrust or unfamiliarity with the medical system, while building personal trust within a hard-to-reach community.

The state has reported four deaths, including two newborns, an 18-year-old and a 40-year-old woman. Officials have administered nearly 4,300 MMR vaccines at pop-up clinics, while Chester County has vaccinated 538 people and nurse Dale Weiser has reached about 100 residents at home; only around a quarter of Amish people in the Lancaster area are estimated to be vaccinated.