Feasibility and Challenges in Implementing Mother-To-Child Transmission (PMTCT) of Hepatitis B Infection in Resource-Limited Settings in Malaysia

Abstract

Mother-to-child transmission (MTCT) is a primary source of hepatitis B virus (HBV) infection in endemic regions. The World Health Organization (WHO) aims to reduce HBV seroprevalence among children under five to less than 0.1% by 2030. In Malaysia, the seroprevalence of hepatitis B surface antigen (HBsAg) in children has declined to 0.4%, but additional measures are needed. A pilot study in Sarawak, Malaysia, screened 474 pregnant women for HBsAg. Those with high MTCT risk received tenofovir disoproxil fumarate from 28 weeks of gestation to 12 weeks postpartum. Infants received timely birth-dose HBV vaccine and hepatitis B immunoglobulin (HBIG) where indicated. Among screened women, 1.9% were HBsAg positive, with 55.6% newly diagnosed. No MTCT cases were observed. Risk factors included maternal age over 35 years old household exposure, and sexual transmission risk. These findings demonstrate the feasibility of WHO’s PMTCT strategies in low-resource settings, supporting nationwide expansion in Malaysia.