The approach reflects a shift in how Pennsylvania health officials are trying to reach communities at risk as the state’s measles outbreak grows. Many Amish residents avoid modern communications technology and value privacy, so officials have worked with religious leaders and community members to spread information through trusted personal connections.

At a clinic held last week at the Robert Fulton Fire Company in Peach Bottom, 79 of the 94 people who came chose to be vaccinated, according to the state. It was the third clinic at the station, whose volunteer fire company includes Amish firefighters. Some families traveled from Quarryville, about 10 miles away, and some hired drivers because many Amish residents do not drive motor vehicles.

Pennsylvania had reported more than 1,300 measles cases by Oct. 26, with Lancaster County accounting for nearly 470 — close to 40% of the statewide total. Two infants and a 20-year-old Lancaster County woman were among six measles-associated deaths identified by state officials and local coroners.

The state began holding pop-up clinics in early May, setting them up in places including fire halls, garages, barns and private homes. The first, in Lebanon County, drew 30 people, 26 of whom received shots, according to the health department. Attendance grew after word spread and officials added evening hours to accommodate farmers working in the fields.

Since then, the state has organized 223 clinics, including 51 in Lancaster County, and vaccinated more than 6,000 people through them. A private appointment for one family can grow into a neighborhood event: At one Lancaster County home, 110 people lined up for shots, said Jennifer Wallace, a pediatrician and medical director of the state’s health centers.

Wallace said officials sought advice from Amish elders and religious leaders before deciding how to reach families and where to offer vaccinations. Keeping clinics discreet can help people feel comfortable attending, and may also reduce the risk of drawing hostile attention, said Beth Smith, a state nurse who has worked for the health department for 27 years.

People at clinics often ask what the vaccine contains and whether it can cause serious effects. Wallace said the measles vaccine is free regardless of insurance status and typically causes, at most, a mild fever or sore arm for a few days. Measles, by contrast, can cause high fever, rash and cough, and can lead to severe complications or death.

The vaccine is not unfamiliar to every Amish family, officials said, and many people who attend decide to get vaccinated. Some mothers have become more concerned about their children contracting measles than about the shot, Wallace said. The outreach is not designed to change the minds of people who have already firmly rejected vaccination, she added.

Measles was declared eliminated in the United States in 2000 after widespread vaccination sharply reduced its spread. Pennsylvania’s current outbreak has renewed the challenge of reaching people who may not have seen the disease before and may not use conventional public-health messaging.