Hand, foot and mouth disease (HFMD) outbreak is a contagious illness and typically occur in the children of less than five years old. The was a marked rise in the number of HFMD outbreak cases was observed in Kelantan, a north-eastern State of Malaysia in 2018. This study aimed to determine risk factors for HFMD outbreak cases to inform potential strategies for prevention and control to reduce the occurrence of outbreak in the population. The data of HFMD cases was collected from Communicable Disease Control Information System (CDCIS) e-Notifikasi, managed by the Disease Control Division, Ministry of Health Malaysia for 2018. Totally, 1026 HFMD data cases were retrieved in the descriptive study. Of the total cases, a comparative cross-sectional analysis was performed on 70 HFMD outbreak cases and 198 non-outbreak cases using simple random sampling. Multiple logistic regression test was done to identify factors associated with HFMD outbreak cases among the children aged under five years old. Home-care (aOR 0.008; 95% CI: 0.001, 0.067, p-value<0.001), attendance to the kindergarten (aOR 0.330; 95% CI: 0.114, 0.957, p-value=0.041) and warm season (aOR 0.154; 95% CI: 0.043, 0.557, p-value=0.004) were found to have a significant association to lower the risk for HFMD outbreak cases in the study. This study was able to identify few significant factors associated with the HFMD outbreak which should be considered by the stakeholders. Further research to evaluate the epidemiology of the HFMD outbreak in Malaysia are needed.