Abstract： Objective:To understand the pathogenic spectrum of hand, foot, and mouth disease (HFMD) in Hebei province from 2018 to 2023, and to analyze the pathogenic changes of HFMD.Methods:The descriptive epidemiological method was used to describe the pathogen detection for HFMD in Hebei province from 2018 to 2023, and to analyze the dynamic changes of HFMD related enteroviruses in Hebei province. Chi-square test was used to analyze the spectrum of pathogens in different populations and regions.Results:From 2018 to 2023, the average annual incidence rate of HFMD in Hebei province was 27.22/100 000, and the overall incidence was high every two years. A total of 22 142 positive samples of HFMD related enterovirus were detected, and the positive detection rate was 76.09%. CVA6 was the most detected, with a detection rate of 35.24%, followed by other HEVs, with a detection rate of 20.35%, and mixed infection was the least detected, with a detection rate of 0.17%. From 2018 to 2023, the dominant pathogen of HFMD in Hebei province continued to change. The dominant pathogen was other HEV in 2018, CVA16 in 2019, and CVA6 during 2020-2023. In other occupational groups, the constituent ratios of CVA6 were high during the six years, while the constituent ratios of EV-A71, CVA10 and other HEV were significantly lower than those in scattered children, children in child care facilities and students. There were some cities with different dominant pathogens during the six years. In 2018, the main pathogen was CVA6 in Shijiazhuang. In 2019, the main pathogen in Chengde, Handan, Tangshan, Xingtai and Zhangjiakou was other HEV and in Hengshui was CVA6. In 2020, the main pathogen was other HEV in Handan, Tangshan. In 2021, CVA16 was the main pathogen in Langfang. In 2022, CVA16 was the main pathogen in Cangzhou, Chengde and Tangshan, and CVA16 was the main pathogen in Xingtai.Conclusions:In recent years, CVA6 has become the dominant pathogen of HFMD in Hebei province. The changes of major pathogens in different populations were basically similar, and the composition and changes of other minor pathogens were slightly different. In some areas, the dominant pathogens were other HEVs, other than EV-A71, CVA16, CVA6 or CVA10. It is necessary to further refine the enterovirus typing work, and to conduct long-term and extensive surveillance on the pathogens of HFMD in Hebei province, so as to understand the epidemiological characteristics and change rules.