A tuberculosis outbreak in western Alabama has killed three adults, the state department of public health confirmed on Thursday. Since January 2014, 26 patients were diagnosed, four of which are children. The state is turning to monetary incentives to get Perry County residents to come in for screening, WIAT reported.

The infection rate in the town of Marion is  greater than those in many third world countries, public health officials said.

“This is a case rate of 253 per 100,000 population in the town of Marion. This far exceeds the TB case rate of 2.5 per 100,000 in the whole state of Alabama in 2015,” the department stated in a media release.

According to Pam Barrett, Alabama’s director of TB control, Marion— population 3,546— has posed obstacles to stop the spread of TB. Of the state’s infected patients, 20 come from the city.

“People just are not willing to give information to our staff,” Barrett told WIAT. “The thing that we’re hoping to accomplish is to find the people who are infected with the bacteria that have not developed disease, that we can get treated preventatively and hopefully find other cases that may be reluctant to come in and be screened.”

To incentivize Perry County residents to come in for screening, from January 11 through Jaunary 29, the Perry County Health Department will give:

• $20 to anyone coming in to be screened for TB by the TSPOT blood test.
• Another $20 for returning after three days to get the result.
• A third $20 for keeping an appointment to get a chest X-ray if it is recommended.
• An additional $100 to a patient if it is recommended he or she take medication and
treatment is completed.

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According to the Centers for Disease Control and Prevention (CDC), tuberculosis is spread through the air from person to person. Symptoms include a bad cough that lasts three weeks or longer, pain in the chest, coughing up blood, fatigue and lack of appetite.

No appointment is necessary for the service, which will take place Mondays, Wednesdays and Fridays from 9 a.m. to 3 p.m.

“We would just like to offer them a little bit of education that there’s nothing to be ashamed of if you have tuberculosis,” Barrett told the news channel. “It’s very treatable, it’s curable, and preventable.”