Objective To analyze pathogens, severe cases and population distribution characteristics of hand foot mouth disease (HFMD) after the launch of inactivated enterovirus A71 (EV-A71) vaccine in China, and to provide references for the prevention and control of HFMD in China.Methods The literature published openly from 2016 to 2025, explicitly involving the application effect evaluation of EV-A71 vaccine and containing basic data such as the changes of pathogens before and after the application of vaccine, severe cases or incidence rates, and population distribution characteristics, was collected from China National Knowledge Infrastructure and comprehensively analyzed by chi-square test.Results The population distribution of HFMD cases before and after the use of EV-A71 inactivated vaccine showed that scattered children accounted for the highest proportion, followed by children in kindergartens and nurseries, and students and other groups accounted for the lowest proportion. However, after the application of EV-A71 vaccine, the composition of scattered children in HFMD cases decreased by 11.35% compared with that before the vaccine application, the proportion of children in kindergartens and nurseries increased by 25.62%, and the proportion of students and others increased by 61.38%. The differences in population distribution before and after the vaccine application were all statistically significant (χ2=15 659.45, 11 028.25, 3 587.36; P<0.001). After the application of EV-A71 vaccine, the average number of HFMD cases caused by EV-A71 decreased by 56.17%, while the average number of cases caused by coxsackie virus A16 (CVA16) and other enteroviruses increased by 8.08% and 62.37%, respectively, and the differences were all statistically significant (χ2=41.94, 310.80, 39.37; P<0.001). Non-EV-A71 enteroviruses (such as CVA16, CVA6 and CVA10, etc.) became dominant pathogens. After the application of vaccine, the average number of severe cases decreased by 42.70%, and the proportion of those caused by EV-A71 in severe cases dropped by 17.89%. The differences were statistically significant (χ2=4 087.32, 4 215.92;P< 0.001). However, approximately 59% of severe cases were still caused by EV-A71 infection after the use of the vaccine, suggesting that EV-A71 remained the main pathogen leading to critical HFMD.Conclusion EV-A71 vaccine has significantly reduced the incidence of severe HFMD cases, but EV-A71 remains the primary pathogen causing severe cases, while non-EV-A71 enteroviruses have become dominant pathogens.