A powerful 4.7 magnitude aftershock hit the area at 6:28 AM local time Friday morning, according to the United States Geological Survey (USGS).
Wednesday's quake nearly leveled the towns of Amatrice, Accumoli and Arquata del Tronto. Of the casualties, 193 have been confirmed so far in Amatrice, 11 in Accumuli and 46 in Arquata del Tronto, according to Italy's Civil Protection agency.
Italy's earthquake institute reported 150 aftershocks in the 12 hours following the initial quake, the strongest measuring 5.5 on the Richter scale.
The Italian government allocated 234 million euros to the search and recovery effort on Thursday, as glimmers of hope buoyed rescue teams who worked through the night in a desperate search for people trapped under collapsed buildings.
Early Thursday, firefighters pulled a 10-year-old girl alive from the rubble in the small town of Pescara del Tronto, nestled in Ascoli Piceno province in the Marche region.
"You can hear something under here. Quiet, quiet," one rescue worker said, according to the Associated Press, before soon urging her on: "Come on, Giulia, come on, Giulia."
Cheers broke out when she emerged from the wreckage.
Meanwhile, another person was rescued by two men who spotted his hand in the rubble of his crumbled home.
"I can only remember that I couldn't breathe," he told The AP from his hospital bed. "I thought I was dead."
Still, the death toll continued to climb as more and more bodies were recovered. Aerial footage showed what little remains of the towns hit hardest by Wednesday's quake.
"Unfortunately, 90 percent we pull out are dead, but some make it, that's why we are here," said Christian Bianchetti, a volunteer from Rieti province who worked through the night in the small town of Amatrice, located in Rieti province in the Lazio region.
The damage was so extensive in Amatrice that Mayor Sergio Pirozzi said, "The town isn't here anymore."
Pirozzi also expressed concern for the approximately 70 guests staying at the town's Hotel Roma, only a handful of whom have so far been pulled out. The historic town's population swells with visitors in the summer months, likely adding to the quake's toll.
Italy's health minister, Beatrice Lorenzin, visited the devastated area Wednesday and noted that many of the victims were children.
Italian Premier Matteo Renzi also visited the zone Wednesday, greeted rescue teams and survivors, and pledged that "No family, no city, no hamlet will be left behind."
The State Deptartment advised U.S. citizens to avoid the region of central Italy near the towns of Amatrice, Accumoli, Arquata del Tronto, and Pescara del Tronto.
"Many roads have been blocked," the State Dept. said in a statement, noting that "numerous aftershocks have already been felt throughout the region, and there is the potential for further aftershocks."
In April 2009, a 6.3 magnitude quake near the town of L’Aquila killed at least 295 people, injured more than 1,000 and left at least 55,000 homeless.
In September 1997, a 6.0 magnitude earthquake in the area killed 11 people and injured more than 100, destroying approximately 80,000 homes in the Marche and Umbria regions.
On Jan. 13, 1915, a magnitude 6.7 earthquake near Avezzano killed approximately 32,000 people.
The Associated Press contributed to this report.