A magnitude 6.2 earthquake has struck central Italy, leaving at least 38 people dead and 150 missing, as rescuers search for survivors.
Many of the dead were in Accumoli, close to the epicentre, and a short distance away in Amatrice, which was largely reduced to rubble.
The village of Pescara del Tronto was levelled to the ground and the number of dead was expected to rise.
The quake hit at 03:36 (01:36 GMT), 100km (65 miles) north-east of Rome.
Prime Minister Matteo Renzi paid tribute to the volunteers and civil defence officials who had rushed to the scene in the middle of the night and used their bare hands to dig for survivors.
Although it struck at a shallow depth of 10km, the quake’s intensity was compared to that of the Aquila earthquake in April 2009 in which 309 people died.
Some buildings in the capital shook for 20 seconds as the quake struck the regional border area of Umbria, Lazio and Le Marche. It was felt from Bologna in the north to Naples in the south. Some 80 aftershocks have been reported since.
Local authorities were unsure of the full extent of casualties but 28 deaths were reported in Accumoli and Amatrice.
Eleven people were reported dead including children in the neighbouring villages of Pescara del Tronto and Arquata del Tronto.
An elderly couple and a boy were among the victims there while 20 people have been taken to hospital. Two boys aged four and seven were pulled alive from the rubble of the house they had been staying in with their grandmother, Ansa news agency reports. Rescuers said they had been sheltering under a bed.
Rescuers were still trying to reach the remote village of Peracchia di Acqua Santa Terme a few kilometres to the east.
Some of the worst damage was in the town of Amatrice, where rescue efforts were under way to find survivors. Among those missing were three nuns.
“The roads in and out of town are cut off,” said mayor Sergio Pirozzi. “Half the town is gone. There are people under the rubble. There’s been a landslide and a bridge might collapse.
“There are tens of victims, so many under the rubble. We’re preparing a place for the bodies.”
The local hospital was described as unusable and survivors were taken to nearby towns for treatment.
The main street through the town has been devastated and emergency workers are trying to reach six people in a collapsed building.
The BBC’s James Reynolds, who is in Amatrice, said that sniffer dogs were being sent into buildings to search for more survivors and local authorities were trying to assess the number of people missing.