Abstract: Objective To analyze the spatial-temporal clustering and pathogen spectrum dynamic change of hand foot and mouth disease(HFMD)in Zhoushan islands,Zhejiang province,and provide evidence for the local prevention and control of HFMD. Methods The incidence data of HFMD and related laboratory test results were collected from China Information System for Disease Control and Prevention. Descriptive epidemiological analysis was conducted and spatial-temporal scan statistic method was used to describe the spatial-temporal clustering of HFMD. Results A total of 3 566 HFMD cases were reported in Zhoushan islands during 2009-2016,with an average annual incidence of 39.04/100 000,the annual incidence peak was during April-July. Most cases occurred in age group 1-3 years,and children outside child care settings were at high-risk. During 2009-2016,three HFMD clustering areas were identified,i.e. Dinghai,Putuo and Daishan,and the clustering time was from June to July. The pathogen spectrum differed with year,EV71 was predominant during 2009-2011,Cox A6 and Cox A16 circulated alternatively during 2012-2016,and Cox A6 was predominant in 2013 and during 2015-2016. Conclusion Three dimensons distribution and spatial-temporal clustering of HFMD were observed in Zhoushan islands, Cox A6 had become the predominant pathogen gradually. It is necessary to conduct population,season and area specific prevention and control of HFMD and strengthen the etiological surveillance for the timely detection of the predominant pathogen of HFMD.