A 30-year-old pregnant woman at 10 weeks gestation is found to be HBsAg positive. Her HBeAg is positive, anti-HBe is negative, and HBV DNA is 2 × 10^8 IU/mL. What is the most appropriate intervention to prevent mother-to-child transmission (MTCT)?
- A Hepatitis B immunoglobulin (HBIG) alone to neonate at birth
- B Tenofovir disoproxil fumarate to mother from 28 weeks + HBIG and HB vaccine to neonate at birth ✓
- C Neonatal HB vaccine at 0, 1, 6 months only
- D Elective caesarean section reduces MTCT sufficiently without antiviral therapy
Correct answer: B. Tenofovir disoproxil fumarate to mother from 28 weeks + HBIG and HB vaccine to neonate at birth
Explanation
High HBV DNA (>200,000 IU/mL) and HBeAg positivity identify mothers at highest risk of MTCT despite neonatal passive-active immunisation. WHO and NTEP guidelines recommend tenofovir disoproxil fumarate (TDF) starting at 28 weeks gestation to reduce maternal viral load, combined with HBIG and three-dose HB vaccine to the neonate. Immunoprophylaxis alone (HBIG + vaccine) reduces but does not eliminate MTCT in high-viraemia mothers. Mode of delivery does not significantly affect MTCT when antiviral prophylaxis is used.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.