Abstract: Objective To understand the epidemiological characteristics of severe and fatal cases of hand foot and mouth disease (HFMD) during the incidence peak period in Shaanxi and provide scientific evidence for the effective treatment of severe cases and reduction of case fatality. Methods By using national disease reporting information system and field epidemiological survey results, the descriptive epidemiological analysis was conducted on the incidence data of severe and fatal cases of HFMD during the incidence peak period in Shaanxi in 2010. Results A total of 51 167 HFMD cases were reported during the incidence peak period, including 26 fatal cases and 262 severe cases, which increased by 108.23%, 116.67% and 204.65% respectively compared with the same period in 2009. Most severe and fatal cases were children outside child care settings. The severe cases and fatal cases in children aged 3 years accounted for 92.37% and 91.65% respectively. The severe cases with a interval of2 days between onset and medical care seeking accounted for 67.94%. Up to 35.50% of the severe cases were laboratory confirmed, in which 87.10% were EV71 infection. For the fatal cases, the average interval between onset and medical care seeking was 0.57 days, the average interval between onset and diagnosis were 2.88 days. Among the fatal cases, nineteen (73.08%) were EV71 infection by laboratory confirmation. Conclusion The severe and fatal cases during the incidence peak of HFMD increased greatly in Shaanxi in 2010 compared with the same period in 2009. Most severe and fatal cases were3 years old children outside child care settings, which were mainly caused by EV71 infection. The interval between the first medical care seeking and diagnosis was 2 days, resulting in the delay in treatment.