Illness has claimed two more victims in the England camp ahead of the first Test against South Africa in Bloemfontein, with centre Andy Farrell and scrumhalf Peter Richards both falling foul of the stomach bug that has swept through squad during the past few days.
Farrell will be replaced by Newcastle centre Toby Flood, which means an all-Falcons midfield of Jonny Wilkinson, Flood and Mathew Tait, while Harlequins' Andy Gomarsall takes over from Richards and makes a first England start in almost three years.
Further changes have been necessary on the bench, with Bristol scrumhalf Shaun Perry and the Gloucester backs Anthony Allen and James Simpson-Daniel receiving call-ups.
The loss of Farrell and Richards was widely expected after both players were unable to take part in yesterday's squad walk-through at Vodacom Park.
It is another setback for Farrell, whose union career since switching codes has been consistently affected by injuries. He has not played for England since the record defeat against Ireland in late February.
Richards's absence means an opportunity for in-form Gomarsall, who has forced his way into the World Cup reckoning on the back of an outstanding season with Quins.
Gomarsall, 32, last played for England against Australia in 2004.
England head coach Brian Ashton has seen the build-up to today's game hampered by a virus that has laid low players and management staff with wing David Strettle being admitted to hospital for extensive re-hydration treatment.
England also lost Gloucester prop Nick Wood, who was to have made his Test debut, due to a torn chest muscle suffered in training on Thursday, which meant a call up for 34-year-old Saracens prop Kevin Yates.
With resources stretched, Ashton also summoned Saracens back Dan Scarbrough from England to join the squad as cover, while Bath prop Matt Stevens flew by private jet from Cape Town to join the tourists.
England have lost their last six away games, and they were already huge underdogs against South Africa after Ashton opted to leave at home a sizeable contingent from European finalists Leicester, Wasps and Bath, but given the further disruption this week it would be a major surprise if England avoid anything other than a landslide defeat.
