Rescuers said they had pulled five bodies from the ruins of the Hotel Roma in Amatrice. As many as 70 tourists were staying at the hotel when the quake struck. Many are feared to be in the rubble, though several were pulled out and given medical care.
Many of those affected were Italians on holiday in the region. Some were in Amatrice for a festival to celebrate a famous local speciality - amatriciana bacon and tomato sauce.
Late on Wednesday there were cheers in the village of Pescara del Tronto when a young girl was pulled alive from the rubble after being trapped for 17 hours. Almost all the houses there had collapsed, the mayor said.
The quake struck small towns and villages in the mountainous area where the regions of Umbria, Lazio and Le Marche meet.
Among the victims was an 18-month-old toddler, Marisol Piermarini, whose mother Martina Turco survived the deadly 2009 earthquake in L'Aquila and moved away from there after the experience, Italian news agency Ansa reported.
Ms Turco was being treated in hospital after being pulled from the rubble in the village of Arquata del Tronto, Ansa said.
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