Prevention of mother to child transmission of hepatitis B

Hepatitis B virus (HBV) is a major cause of morbidity and mortality worldwide with a high prevalence in resource limited settings (RLS) like the Thailand-Myanmar border (6.2%). In these settings the main route of transmission is from mother to child (MTCT). Chronic HBV infection can progress into liver failure, liver cirrhosis and liver cancer which lead to death in 25% of the perinatally infected patients. There is no curative treatment for HBV and the main target to stop the HBV epidemic is preventing MTCT. The current strategy for preventing MTCT is by vaccination, a birth dose vaccine followed by three additional vaccinations later in life, combined with the administration of hepatitis B immunoglobulins (HBIG) after birth. In RLS these strategies are challenging due to home deliveries, people living far away from clinics, absence of a cold chain and presence of out-of-pocket expenditure. Moreover, even with perfect administration of HBIG, birth dose and three vaccinations, MTCT can still occur in 8-32% of the cases. An additional way of preventing HBV transmission is by maternal treatment with Tenofovir Disoproxil Fumarate (TDF), that reduces the HBV DNA load to a minimum at the time of delivery. TDF after rapid diagnostic test is a cost-effective option in a RLS if given at the correct time and dosage. Focusing on the wellbeing of mothers and children would not only support HBV elimination but also contribute to strengthening maternal and child health and achieving the health component of the Sustainable Development Goals in the wider context.