Thirty people have been killed after a coach came off a flyover and plunged down a 98ft slope, according to the ANSA news agency.
Children were said to be among the passengers on the bus that crashed at Avellino in southern Italy.
The 40 passengers were said to have been returning to Naples following a pilgrimage.
A police spokesman said: "I cannot yet confirm the number of victims, we are still pulling people from the vehicle. Our priority now is to free the wounded."
A spokesman for the fire service said rescue operations were continuing and that four young children had been pulled alive from the stricken coach.
"The situation is dramatic," he said, adding that several other vehicles had also been involved in the accident.
Rescue workers at the scene said the bus had hit several cars before coming off the road and added that some of the passengers could have been flung from the vehicle as it fell.
Witnesses claimed it appeared the coach may have had braking problems, although officials had yet to confirm any cause of the accident. The driver is said to be among the dead
The Naples-Bari highway has been closed to traffic.
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