A tetanus outbreak among injecting drug users is suspected of killing one woman and causing illness in five others.

Public health officials yesterday said more cases were expected. Most of the women are in their 20s. Five of the cases have occurred in the last fortnight, in north-west England, the West Midlands and the south-west. The sixth case dates from July and it is not known whether it is linked.

Tetanus normally affects just a handful of Britons each year - mainly older women infected by contaminated soil while gardening. Of 175 tetanus cases identified between 1984 and 2000, only two have previously been known to have been injecting drug users.

Urgent warnings are being sent to drug action teams and hospitals, as quick treatment can be life-saving.

The "trademark" tetanus symptom is muscle spasms in the jaw, neck, back and abdomen. Death occurs in around three in 10 patients. A national programme of childhood immunisation since 1961, along with booster jabs for adults, has virtually eliminated the disease.