Dengue, an important acute febrile disease, is transmitted by Aedes aegypti or Ae. albopictus mosquitoes and is caused by infection with dengue virus (DENV) [1, 2]. Historically, DENV spread across tropical areas in the eighteenth and nineteenth centuries [2]. However, in the following twentieth and twenty-first centuries, this disease gained powerful momentum for epidemic activity due to radical growth and massive migration of human population, extensive urbanization, modern transportation systems, global trade, climate change, and the lack of effective mosquito control [2, 3]. Specifically, the comprehensive revival of regional economies and urban development following World War II, coupled with the expansion of civil aviation in the 1970s, accelerated global communication and broadened the regions susceptible to dengue outbreaks [2, 3]. These factors have contributed to the drastic increase of dengue cases globally. Currently, an estimated 390 million new cases occur annually worldwide, affecting a population of approximately 2.5 to 4 billion and posing a formidable threat to global public health [4]. Consequently, the rapid spread of the disease has also resulted in a series of invasive outbreaks in temperate countries, such as Italy, Spain, and northern China [5,6,7,8].

In May 1978, a dengue outbreak, caused by DENV-4, was reported in Foshan City, Guangdong Province, China [9]. Subsequent years witnessed recurrent outbreaks with a substantial number of DENV infection cases, particularly in 1978, 1980, and 1986 in Hainan and Guangdong Province [9]. From 1990 to 2012, a discernible pattern of milder epidemics and periodic outbreaks emerged, especially in 1995, 2002, and 2006, when the number of infections exceeded one thousand in number, with notably high infection rates documented [10,11,12]. The extensive outbreak during the period of 2013–2014 marked a shift, with multiple serotypes of DENVs co-circulating in China, predominantly in Guangdong and Yunnan provinces [13, 14]. Despite the extensive epidemic reports in China, the majority of historical accounts of prevalent diseases in China only extend back to the 1978 dengue outbreak in Foshan, Guangdong [10, 11, 15]. While historical records document numerous epidemics with symptoms similar to dengue fever analyses on the pre-1978 documents are scarce.

This study aims to shed light on the history of dengue epidemics in China prior to 1978, by examining evidence from ancient Chinese literature and conducting comprehensive reviews. The findings identify potential epidemiological events that could elucidate the pre-1978 history of dengue in China.