Once the leading cause of death in the United States, tuberculosis is back in the spotlight as a health threat, this time in rural Alabama. The potentially serious infectious disease continues to spread across the local population of Marion, where state health officials cite the community’s longtime mistrust of medicine and endemic poverty as contributing causes of the outbreak, reports the New York Times.

At press time, this bacterial disease that mainly affects the lungs had killed three people. Officials said 20 people had been diagnosed with an active tuberculosis infection in the small town of 3,600 people, and more than two dozen others had developed a latent form of the disease.

Tuberculosis, a.k.a. TB, is spread through the air from one person to another and is commonly characterized by a bad cough that lasts three weeks or more. An active tuberculosis infection can be cured, but it can also be fatal without proper or timely treatment. Local health authorities also stressed that the chance of developing TB is far more common in people living with HIV or diabetes, and in those who use alcohol or drugs.

The scope of Alabama’s tuberculosis outbreak is estimated to be so severe that the Perry County Health Department, where Marion is located, is now offering residents financial incentives to get tested for the illness. They will receive $20 to get tested, $20 for attending a follow-up visit and $20 for keeping an appointment for a chest X-ray. Anyone who is diagnosed with TB can get up to $100 for completing treatment.

Authorities said the first few days of incentivized testing have brought nearly 800 people to the town’s health department. But officials also warned that Marion’s battle against TB is far from over. Experts said the number of new infections could easily reach into the hundreds, possibly thousands, as more people are tested.

How well prepared are we to handle disease outbreaks in the United States? Click here to read more.