A powerful earthquake shook Italy's industrial and densely populated northeast early Sunday, killing at least six people, felling homes and factories and reducing historic buildings to rubble.
Emergency services said dozens had been injured in the magnitude 6.0 quake, which struck in the middle of the night, sending thousands of people running into the streets in towns and cities across the Emilia Romagna region.
Emergency workers were sifting through the rubble of collapsed buildings for victims, hours after the quake and several aftershocks struck at 0200 GMT.
Four of the dead were night-shift workers in factories which collapsed, including two who were crushed when the roof of a ceramics factory caved-in in the town of Sant'Agostino.
A 37-year-old German woman and another woman aged over 100 were reported to have died from shock.
The quake caused "significant" damage to historic buildings as it rattled the cities of Bologna, Ferrara, Verona and Mantua, Italy's culture ministry said.
"According to first reports, damage to the cultural heritage is significant," the ministry said, adding that it was carrying out "more detailed verifications with firemen and the civil protection service."
Italian television showed many historic buildings, including churches, reduced to rubble. Cars had been crushed under falling masonry, and the Civil Protection Agency had evacuated hundreds of elderly and vulnerable people to makeshift communal shelters in Finale Emilia and towns near the epicentre.
The roof of a recently renovated sixth-century chapel in San Carlo, near Ferrara, caved in, exposing statues of angels to the sky.
Claudio Fabbri, a 37-year-old architect, told AFP the restoration had taken eight years. "Now there's nothing left to do," he said despondently.
People were out in the street, fearful of going indoors, as the odour of gas hung in the air.
Retired electrician Claudio Bignami, 68, said: "I went out because I felt the house moving. Furniture was falling over. It was chaos. Everyone was running in every direction."
Aldra Bregoli, 73, who had pulled on a sweater over her nightgown, said: "I had to get out quickly. I can't go back home. I'm afraid."
Authorities said the quake's epicentre was the commune of Finale Emilia, 36 kilometres (22 miles) north of Bologna, at a depth of only 5.1 kilometres (3.2 miles).
One of the men killed in the ceramics factory collapse, Nicola Cavicchi, 35, "wanted to go to the seaside but because of the bad weather forecast he decided to go to work to replace a colleague who was sick," a family member told local media.
A 29-year-old Moroccan man was killed by a falling girder when a factory building collapsed in the small town of Ponte Rodoni di Bondeno.
The body of a fourth night-shift worker was found in the early afternoon under fallen masonry at a factory in a nearby village.
In Finale Emilia, firefighters rescued a five-year-old girl who was trapped in the rubble of her house after a rapid series of phone calls between a local woman, a family friend who was in New York and emergency services.
The region shaken by the quake is Italy's industrial heartland but also home to priceless architectural and art treasures. The historic centre of Ferrara is classified as a UNESCO World Heritage site.
Hospitals were evacuated as a precautionary measure.
Telephone switchboards of emergency services were inundated with calls immediately after the quake.
Earlier a 4.1 magnitude quake shook the Lombardy region around Milan, Italy's financial and business capital, and was felt in the historic cities of Modena, Mantua and Rovigo as well as Ferrara.
Seismic experts said the relatively small size of the aftershocks meant the worst was likely over.
In a show of calm nerves, officials opened polls as planned for the second round of local elections in the cities of Piacenza, Parma, Budrio and Comacchio.
Enzo Boschi, a reputed seismologist in Italy, said: "It is not true that there are never earthquakes in the Po plain. Ferrara suffered a very big one in the 15th century. You can still see the traces."
"Italy is a very quake-prone country. What we can say is that 5.9 or 6.0 is the maximum strength there has ever been in these zones in the past."
In March 2009, a 6.3 magnitude quake devastated the central city of l'Aquila, killing some 300 people and leaving tens of thousands homeless.