Abstract: Objective To understand the epidemiological characteristics of severe and fatal cases of hand, foot and mouth disease(HFMD) in Ningde, Fujian province, during 2008-2011 and provide evidence for the early diagnosis of HFMD and the development of prevention and control strategies. Methods Descriptive epidemiological analysis was conducted on the incidence data of HFMD, including the data of severe and fatal cases, and the results of real time quantitative PCR detection in Ningde during this period. Results A total of 16 760 HFMD cases, including 80 severe cases(4.77) and 6 deaths(0.36), were reported from 2008 to 2011 with the annual incidence of 1.63,1.45,7.23 and 4.93 respectively. The annual incidence peak of severe cases was during April-October. Up to 83.75% of severe cases occurred in children aged 3 years and EV71 was the major pathogen. The 6 fatal cases were children aged 3 years after the infection of EV71. The early clinical manifestations of the severe cases was mainly high fever, rash was not apparent. Most fatal cases occurred rapidly duo to the misdiagnosis by village doctors in rural areas. Conclusion The incidence of HFMD increased year by year with more severe cases and fatal cases reported in NIngde. It is necessary to strengthen the monitoring and the early diagnosis of severe cases to prevent the death causing by HFMD.