Rescue teams have been struggling to reach some areas but officials say the situation is not “catastrophic”.
A quake rocked the same region in August, killing at least 298 people.
Wednesday evening’s 5.5-magnitude quake struck near Visso in Macerata province, followed by a 6.1 magnitude tremor in the same area two hours later.
The first tremor sent people running out of their houses, potentially saving lives when the second stronger quake struck. Numerous smaller aftershocks followed.
any houses have been badly damaged, forcing out hundreds of residents, who spent the night in cars and emergency shelters. Temporary shelter was being offered to people whose homes were at risk.
The quakes were felt across central Italy, including in the capital, Rome, where buildings shook and doors and windows rattled.
The mayor of Ussita, 5km (3 miles) west of Visso, told Sky Italia: “Many houses have collapsed. Our town is finished.”
In Visso itself, Mayor Giuliano Pazzaglini said about two-thirds of buildings were unsafe and there was a shortage of drinking water and adequate sanitation. He said most of the buildings damaged had already been weakened by the 24 August earthquake.
Police were reported to be restricting access to Visso’s historic centre after the quake brought boulders down on to nearby roads.
The town of Camerino is also thought to have been badly damaged.
In Campo, near Norcia in the Umbria region, the 15th-Century San Salvatore church collapsed. It had been weakened by the earthquake in August.
The light of day after a night of torrential rain has allowed emergency workers here to get a better picture of the damage.
The scenes in the affected areas are nothing like the devastation we saw in the town of Amatrice just over two months ago. That also explains the lack of casualties after the two strong tremors.
Locals here are worried, however, that the damage to tourist attractions in the area, like some centuries-old churches, may badly affect the coming winter tourist season.
And the series of strong aftershocks overnight is making people anxious here.
But Italy’s civil defence chief, Fabrizio Curcio, said the situation was not “as catastrophic as might have been expected” despite the problems caused by boulders.
As teams worked through the night, Prime Minister Matteo Renzi tweeted: “I want to thank those working in the rain in the earthquake zones. All of Italy is wrapping its arms around the communities that have been hit once again.”
Visso is 70km (45 miles) from Amatrice, which was badly damaged in the 6 magnitude quake in August.
The new tremors are linked to the quake of two months ago, Italian officials say.
“Aftershocks can last for a long time, sometimes for months,” AFP news agency quoted Mario Tozzi of Italy’s National Institute of Geophysics as saying.
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