At least 13 people were killed as a magnitude 6.2 earthquake struck central Italy early on Wednesday, officials said.
Many were trapped under rubble as buildings and houses collapsed due to the tremors that were also felt in the country's capital city of Rome, BBC reported. Some buildings shook for 20 seconds.
"Half the town is gone," said the mayor of Amatrice, one of the worst hit area.
A family of four was feared dead as their house collapsed in the nearby town of Accumoli.
The quake hit at 3.36 a.m., around 100 km north-east of Rome, at a shallow depth of 10 km.
Officials warned the number of fatalities was likely to rise.
The head of the civil protection department compared the earthquake's intensity to Aquila in April 2009 in which 309 people died.
Several people died in Amatrice and rescue efforts were under way to find survivors.
"The roads in and out of town are cut off. Half the town is gone. There are people under the rubble. There's been a landslide and a bridge might collapse," mayor Sergio Perozzi said.
The main street through the town has been devastated and emergency workers were trying to reach six people in a collapsed building.
Meanwhile police said two people had died in the village of Pescara del Tronto.
Italian authorities warned of the risks of after-shocks in the coming hours.
Italy's Civil Protection agency described the earthquake as "severe".
Rescue teams were being sent to the worst-hit areas, the Prime Minister's office said.
The US Geological Survey reported the intensity to be magnitude 6.4.
The deputy editor of the British newspaper, The Times, who was in the area at the time, told the BBC that the quake lasted about 20 seconds followed by an aftershock about 20 minutes later which was easily as strong.
Norcia Mayor Nicola Alemanno said no deaths have been reported in the town. Many historic buildings and heritages are located there.
"The anti-seismic structures of the town have held," he said. "There is damage to the historic heritage and buildings but we do not have any serious injuries."
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