The death toll in the Italian earthquake stands at 241 as rescuers continue efforts to find survivors.
Dozens of people are believed trapped in ruined Amatrice, Accumoli and Pescara del Tronto, in mountainous central Italy.
There have been hundreds of aftershocks since the quake struck, hampering relief efforts and damaging already unstable buildings.
More than 4,300 rescuers are using heavy machinery and their bare hands.
Rescuers have advised journalists and bystanders to leave Amatrice urgently, as “the town is crumbling”, the BBC’s Jenny Hill says.
Another powerful aftershock struck the town on Thursday afternoon, sending a huge dust cloud into the air.
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Many of the earthquake’s victims were children, the health minister said, and there were warnings the toll could rise further.
The heaviest death toll was in Amatrice – 184, officials said. Another 46 died in Arquata, and 11 in Accumoli. A further 264 people have been treated in hospital.
Officials revised down the number of dead after earlier giving a figure of 247.
The 6.2-magnitude quake hit at 03:36 (01:36 GMT) on Wednesday 100km (65 miles) north-east of Rome.
“We are sleeping in the car and there were shocks all night. When the biggest one came, the car started moving and shaking,” said Monica, a survivor from Amatrice.
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.