A 4.0 magnitude earthquake struck the Italian holiday island of Ischia late Monday, causing destruction that left one person dead and one missing at peak tourist season, authorities said.

A woman was killed in Casamicciola, in the north of the small tourist island, hit by debris that fell from a church, with around 25 people injured in the quake, for the most part lightly.

At a press conference early Tuesday, the head of the local department of civil protection, Angelo Borrelli, said that two small communes, Casamicciola and neighbouring Lacco Ameno, had borne the brunt of the quake.

"In Casamicciola, a building collapsed and three people were pulled alive from the rubble -- two women and a man," he said.

Rescue workers were working in the early hours to free three children who were alive but trapped and communicating with emergency services through the rubble, the mayor of Casamicciola told Italian television.

The tremor hit the northwest of the island at 8:57 pm (1957 GMT), with a depth of some 10 kilometres.

Italian authorities first put Monday's quake at 3.6, but subsequently revised it upward to 4.0 magnitude.

The main earthquake was followed by 14 smaller aftershocks, said Angelo Borrelli.

It came just days ahead of the first anniversary of the 6.0 magnitude quake that killed nearly 300 people in and around Amatrice in central Italy. In October 2016 and January 2017 three other earthquakes hit the same region.

"I was on the couch watching TV. Blackout, shaking, something fell on my head. I scream, my mother grabs me and we ran outside," one witness wrote on Twitter.

The quake response has benefited from the presence of emergency responders who happened to already be on the island to fight the forest fires that have plagued Italy this summer, local media said.

Teams of firefighters, including two units specialised in extracting people from the rubble, were quickly mobilised, said Bruno Frattasi, who oversees the fire department.

Firefighters said on Twitter that several buildings on the island were damaged or had collapsed.

Ischia's only hospital was also hit and had to be partially evacuated. Five patients were evacuated to another medical facility by helicopter.

Restaurants were packed and many stores were still open when the shaking began, witnesses said on Twitter.

"A horrible experience, everything was shaking, plunged into darkness, houses were collapsing... a nightmare," a witness wrote on Twitter.

Electricity was restored after just a few minutes, but many people stayed outdoors after the quake, reluctant to go inside.

Ischia has been a frequent victim of earthquakes, with its worst dating back over a century. Estimated at a magnitude of 5.8, it killed over 2,000 people in July 1883.

Much of Italy's land mass and some of its surrounding waters are prone to seismic activity with the highest risk concentrated along its mountainous central spine.

Italy straddles the Eurasian and African tectonic plates, making it vulnerable to seismic activity when they move.

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