Rina Miyake, a 9-year-old girl, died on her way to school after a wall several dozens of meters long around a swimming pool collapsed on her in Takatsuki, while Minoru Yasui, an 80-year-old resident of Osaka's Higashiyodogawa Ward, was killed after a wall collapsed over him.
At least 61 people were injured, according to an official tally at 11.45am local time (10.45am in Singapore). Municipal authorities have confirmed three deaths in Osaka and a nearby city, a 9-year-old girl and two men in their 80s.
The Japan Meteorological Agency says a quake with preliminary magnitude of 5.9 struck Monday around 8 a.m.
In a 1995 deadly quake in the region, which had a magnitude of 7.3 and recorded 7 on the Japanese seismic intensity scale, 6,434 people were killed.
No tsunami warning was issued. It also cracked roads and broke water pipes, leaving homes without water.
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Train and subway service including the bullet train have been suspended to check for damage to equipment.
No abnormalities were reported at the Takahama, Mihama and Oi nuclear plants in central Japan, according to Kansai Electric.
Osaka Gas Co. said it suspended gas supply to 108,000 households in Osaka Prefecture following the quake, while more than 170,000 homes in Osaka and neighboring Hyogo Prefecture are suffering a blackout, Kansai Electric Power Co. said. It was a strong vertical jolt.
An natural disaster with a preliminary magnitude of 5.9 hit western Japan on Monday but the top government spokesman said there were no immediate signs of major damage. "I plan to take water to them now".
"I was stunned. I couldn't do anything", he told AFP from Itami, a city in eastern Osaka region.
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Japan's Fire and Disaster Management Agency said two people were found with no vital signs and 41 others had been injured. "The whole world was aggressively shaking".
Government spokesman Suga also cautioned "there is a possibility that strong aftershocks will happen".
Copyright 2018 The Associated Press. The epicentre of Monday's quake, which the JMA said occurred at a depth of 13km, was about an hour to the north of the main entertainment district of Dotonbori. Then the ground shook and swayed quite dramatically for about a minute.
"I could see the overhead electricity cables outside my house shake quite a lot".
Quakes are common in Japan, part of the seismically active "Ring of Fire" that sweeps from the South Pacific islands through Indonesia and Japan, across to Alaska and down the west coast of North, Central and South America.
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The quake struck an important industrial area of central Japan.