Abstract: Objective To understand the epidemiological characteristics of severe hand foot and mouth disease (HFMD) in the mainland of China and provide scientific evidence for severe HFMD prevention and control. Methods Descriptive epidemiological analysis was conducted the distributions of severe HFMD in China from 2008 to 2011 by using geographic information system (GIS). Results A total of 5 020 994 HFMD cases were reported in China during this period. In which 61 623 were severe cases (123/10000). Totally 69.42% of severe cases occurred during April-July. The major pathogens of severe cases were EV71 (81.75%), Cox A16 (4.52%) and other enteric virus (13.73%) according to laboratory detection results. The male to female ratio of severe cases was 1.866:1; Up to 93.13% of severe cases occurred in children aged 3 years. Most severe cases were children outside child care settings (85.97%), followed by children in child care settings (12.72%). The severe cases were mainly detected in southern and central China during this period. Conclusion Severe HFMD mainly occurred in spring and summer and in children aged 3 years. The incidence was higher in males than in females. Children outside child care settings were at high risk. The incidence of severe HFMD showed a increase and decline trend. The incidence intensity varied obviously with region. Central and southern China were the regions with high incidences, which might be attributed to the climate and population density factors in these regions.