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Alex Matthews has become the latest World Cup-winning England forward to be ruled out of this season's Women's Six Nations.
In a statement issued Tuesday announcing the team to play Italy in Parma this weekend, England confirmed No 8 Matthews would miss the last two rounds because of a shoulder problem. She is due to have surgery later this week.
Sadia Kabeya went off in the victory over Wales in the previous round, meaning eight of the 13 forwards from last year's 33-13 World Cup final victory over Canada at Twickenham -- a match where Matthews scored two tries -- will be absent from the Italy game.
Lark Atkin-Davies, Rosie Galligan, Zoe Stratford and Abbie Ward were ruled out of the Championship because of pregnancy, and Hannah Botterman has been injured.
Morwenna Talling and Matthews both suffered tournament-ending injuries in the opening round, but Matthews initially stayed with the squad.
Haidee Head, named on the bench for Saturday's match against Italy, could become England's fourth debutant this Championship.
The 22-year-old back-row, born in Australia, qualifies for England through her mother and joined London club Trailfinders at the start of this season.
England star Ellie Kildunne will start on the wing for the second time this tournament rather than in her more familiar role of full-back -- the position she occupied in a 62-24 thrashing of Wales.
Emma Sing returns at full-back while Megan Jones, the captain, continues in the centres alongside Helena Rowland, who will win her 50th cap in Parma.
Despite all their injury woes, England are on a record run of 36 games unbeaten in all competitions.
And with two rounds to go, a Red Roses team coached by former men's All Blacks boss John Mitchell, are on course to win an eighth straight Six Nations title and fifth consecutive Grand Slam.
England will be huge favourites to defeat Italy, for all the hosts hammered Scotland 41-14 in the previous round.
"We've built momentum throughout this tournament by stacking strong moments together and that will be crucial again this weekend," said Mitchell.
"Italy will be full of confidence after their result against Scotland and they'll challenge us in different ways."
England (15-1)
Emma Sing; Mia Venner, Megan Jones (capt), Helena Rowland , Ellie Kildunne; Zoe Harrison, Lucy Packer; Maddie Feaunati, Marlie Packer, Demelza Short; Delaney Burns, Abi Burton; Maud Muir, Amy Cokayne, Kelsey Clifford
Replacements: Connie Powell, Mackenzie Carson , Sarah Bern, Haineala Lutui, Haidee Head, Flo Robinson, Holly Aitchison, Claudia Moloney-MacDonald
Coach: John Mitchell (NZL)
A.Novak--TPP