Abstract: Objective To understand the epidemiological and etiological characteristics of severe cases of hand foot and mouth disease (HFMD) in Liaoning province during 2009-2013 and provide evidence for the prevention and control of HFMD. Methods Descriptive epidemiological analysis was conducted on the incidence data of severe cases of HFMD in Liaoning during this period and pathogen detection was conducted too. Results The reported number of severe cases of HFMD was highest in 2010, The case fatality rate decreased year by year, and the annual incidence peak was during July-August. The most cases were young children aged 1-5 years. EV71 was the major pathogen, but its proportion in all pathogens in different place was different. The clinical symptoms included fever and rash usually accompanied by symptoms of the nervous system. Conclusion The incidence of severe HFMD in Liaoning showed a downward trend. EV71 was the major pathogen causing HFMD. It is still necessary to further strengthen surveillance of HFMD in Liaoning.