WATCH: At least ten killed in massive earthquake in Italy

Numerous buildings collapsed in small communities close to the epicentre of the quake in a remote, thinly-populated area straddling the regions of Umbria, Marche and Lazio.

As dawn broke, residents and emergency services were scrambling to rescue people trapped in rubble. Local officials indicated that the death toll was likely to rise.

Fabrizio Curcio, the head of Italy's civil protection service, classed the quake as "severe". The shocks were strong enough to wake residents of central Rome, some 150 kilometres (90 miles) away.

The first two confirmed victims were an elderly couple whose home collapsed in Pescara del Tronto in the Marche region, according to local police.

Voices under rubble 

Two corpses were recovered from rubble in Amatrice, a mountain village in neighbouring Lazio that was packed with visitors at the peak of the summer season.

"Half the village has disappeared," said Sergio Pirozzi, Amatrice's mayor.

He said access to the village had been blocked, making it impossible for emergency services to get through.

"There is a landslide on one road, a bridge is about to collapse on the other one," he said, according to the AGI news agency.

"We can hear voices under the rubble."

Amatrice is famous in Italy as a beauty spot and is a popular holiday destination for Romans seeking cool mountain air at the height of the summer.

The first quake struck shortly after 3.30 am (0130 GMT), according to the United States Geological Survey, and a 5.4 magnitude aftershock followed an hour later.

USGS's PAGER system, which predicts the impact of earthquakes, issued a red alert - suggesting significant casualties and damage based on previous quake data.

A resident of the Rieti region, which is between Rome and the epicentre of the quake, told the Rainews24 channel that she and most of her neighbours had come out onto the street after feeling "very strong shaking".

In 2009 a 6.3-magnitude earthquake struck close to the city of Aquila in the Abruzzo region and left more than 300 people dead.

That disaster led to lengthy recriminations over lax building controls and the failure of authorities to warn residents that a quake could be imminent.

Another quake hit the northern Emilia Romagna region in May 2012, when two violent shocks 10 days apart left 23 people dead and 14 000 others homeless.