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The death toll could climb in coming days because communications were down in much of the rugged Hindu Kush mountain range where the quake was centered.
In one of the worst incidents, at least 12 girls were killed in a stampede to flee their school building in Taloqan, just west of Badakhshan province where the tremor's epicenter was located.
"They fell under the feet of other students," said Abdul Razaq Zinda, provincial head of the Afghan National Disaster Management Agency, who reported heavy damage in Takhar.
Shockwaves were felt in New Delhi in northern India and across northern Pakistan, where hundreds of people ran out of buildings as the ground rolled beneath them. No deaths were reported in India.
"We were very scared ... We saw people leaving buildings, and we were remembering our God," Pakistani journalist Zubair Khan said by telephone from the Swat Valley northwest of the capital Islamabad.
"I was in my car and, when I stopped my car, the car itself was shaking as if someone was pushing it back and forth."
The quake was 213 km (132 miles) deep and centered 254 km (158 miles) northeast of Kabul in Badakhshan province. The U.S. Geological Survey initially measured the magnitude at 7.7, then revised it down to 7.5.
Just over a decade ago, a 7.6 magnitude quake in another part of northern Pakistan killed about 75,000 people.
In Afghanistan, where rescue and relief work is likely to be complicated by security threats created by an escalating Taliban insurgency, at least 52 people were reported dead in several provinces.
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