Thousands of rescuers are working around the clock amid hundreds of aftershocks in the crumbling Italian villages of Amatrice, Accumoli and Pescara del Tronto as the death toll from a powerful earthquake continues to rise.

The death toll had reached 247 by Thursday night, with dozens of bodies still believed trapped under their homes in the mountainous region and almost 400 injured.

One hotel that collapsed in the small town of Amatrice probably had about 70 guests and only seven bodies had been recovered so far, said Sergio Pirozzi, the mayor of the one of the worst-hit towns.

Yet amid the grim and dangerous task of recovering bodies from the devastated towns, rescuers were rewarded by something of a miracle when a 10-year-old girl was pulled alive from the rubble in Pescara del Tronto, 17 hours after the quake rocked central Italy.

Video of the rescue shows firefighters searching the debris and finding the legs of the girl, named as Giulia, then carefully removing the rubble to pull her free.

Cheers and applause go up as she is carried away by a firefighter.

Watch the girl being rescued:

Scores of buildings were reduced to dusty piles of masonry in communities close to the epicentre of the quake, which had a magnitude of between 6.0 and 6.2.

Gallery: See the devastation in pictures

The Civil Protection department in Rome said a tally by local officials showed that 190 people were killed in Rieti province and 57 in the province of Ascoli Piceno.

Many of the victims were children, health minister Beatrice Lorenzin said amid warnings the toll will rise further.

Rescuers are using dogs to help locate victims. Photo: EPA/AAP

Rescuers have advised journalists and bystanders to leave Amatrice urgently, as “the town is crumbling”, the BBC’s Jenny Hill said.

She reported that new cracks have appeared in the town’s hospital after strong aftershocks.

The region, around 150 km from Rome, is popular with tourists during summer. Amatrice was also preparing to hold a festival to celebrate its famous local speciality – Amatriciana bacon and tomato sauce.

More than 4300 rescuers, including six members of the Vatican fire department, are using heavy lifting equipment and their bare hands in the rubble.

The town of Amatrice devastated by the earthquake. Photo: PA/AAP

The workers are racing against the clock to find people trapped under the ruins, but hope is diminishing as reports of voices from under collapsed buildings drop off.

A man working on the recovery mission in Amatrice told Channel Nine the once picturesque town was now “like Syria”.

“It is a total war zone in there,” he said.

Red Cross worker Tommaso Della Longa told Italy’s Public Radio International Amatrice was a “nightmare even though you are alive”.

“It’s like an apocalypse,” he said. “I can’t use other words.”

Survivors have been warned to leave the area of Amatrice. Photo: PA/AAP

Prime Minister Matteo Renzi cancelled a planned trip and was due to chair an emergency cabinet meeting on Thursday local time. The agenda included reconstruction plans for the devastated area.

The earthquake struck at 11.36am Wednesday (AEST) and was felt from the Lazio region into Umbria and Le Marche on the Adriatic coast.

Homes throughout the region collapsed as their residents slept, while rocks and metal tumbled onto the streets as dazed survivors huddled in piazzas.

Dozens of aftershocks continued into the early morning hours, some as strong as 5.1.

It was Italy’s most powerful earthquake since 2009, when some 300 people died in and around the city of L’Aquila, just to the south of the area hit on Wednesday.

-with agencies