MARION, Ala. (AP) – Public health officials say another case of tuberculosis has been confirmed amid an outbreak in rural Alabama that has killed three people since 2011.

Alabama Department of Public Health officials said in a statement Thursday that another person has tested positive for the airborne bacterial infection in Marion, a city of roughly 3,600.

Division of Tuberculosis Control Director Pam Barrett says 27 people with some connection to the city have tested positive for the disease since 2014 and 21 are Perry County residents.

Officials say 1,058 county residents have been tested, and 49 have latent infections and will receive preventative treatment. Tuberculosis disease is contagious. Latent infections aren’t, but they can develop into tuberculosis disease.

Officials are paying residents to be tested, get results and follow up with recommended treatment.