Dear Editor,
We read with great interest the delightful response [
1] to our editorial [
2] on the recent article addressing prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) [
3]. We would like to thank the authors for drawing attention to HBV elimination efforts. Their study highlights the importance of modifying maternal factors in addition to the traditional active-passive immunization of infants.
We strongly agree on the importance of identifying highrisk mothers with chronic HBV and preventing MTCT through antiviral prophylaxis. This approach may also be practical for health insurers: Park et al. showed that adding maternal antiviral prophylaxis is more cost-effective than infant immunization alone in South Korea [
4]. Of course, timely access to maternal HBV testing and antiviral prophylaxis may not be feasible in resource-limited settings. For women whose HBV viral suppression has not been achieved by delivery, a risk-based approach, including elective cesarean section, may be considered. We also agree that breastfeeding should not be discouraged for infants who have received HBV immunoglobulin and vaccination. Although the risk of blood-borne transmission from cracked nipples may be low, caution is warranted, as bleeding could theoretically increase transmission risk. The United States Centers for Disease Control still recommends temporarily stopping breastfeeding when there is bleeding at the nipple or areola [
5].
We are grateful for the authors’ valuable proposals. The two key recommendations, integration of maternal HBV DNA testing into the current South Korean program and prescription of antiviral prophylaxis to those at high transmission risk, are critical steps toward reducing HBV transmission and achieving elimination. We hope that these will be incorporated into future public health policies.
FOOTNOTES
-
Authors’ contribution
Conception or design of the work: E. Choi and Y-S. Lee; Drafting the article: E. Choi and Y-S. Lee; Critical revision of the article: E. Choi and J.H. Lee; Final approval of the version to be published: Y-S. Lee.
-
Acknowledgements
This study was supported by a National Research Foundation of Korea grant from the Korean government (the Ministry of Education, Science and Technology, RS-2021-NR061523), a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), South Korea funded by the Ministry of Health & Welfare, Republic of Korea (RS-2024-00439963), and Korea University Guro Hospital (KOREA RESEARCH-DRIVEN HOSPITAL) and Korea University (K2512711).
-
Conflicts of Interest
The authors have no conflicts of interest to declare.
Abbreviations
mother-to-child transmission
REFERENCES
- 1. Ki M, Kim JH. Redefining MTCT prevention strategies toward HBV elimination: Correspondence to editorial on “Factors associated with hepatitis B mother-to-child transmission in a national prevention program”. Clin Mol Hepatol 2026;32:e224-e226.
- 2. Choi E, Kim JH, Lee YS. Redefining MTCT prevention strategies toward HBV elimination: Editorial on “Factors associated with hepatitis B mother-to-child transmission in a national prevention program”. Clin Mol Hepatol 2026;32:943-945.
- 3. Ki M, Kim BW, Baik D, Kim JH. Factors associated with hepatitis B mother-to-child transmission in a national prevention program. Clin Mol Hepatol 2025;31:1298-1315.
- 4. Lee D, Shin HY, Park SM. Cost-effectiveness of antiviral prophylaxis during pregnancy for the prevention of perinatal hepatitis B infection in South Korea. Cost Eff Resour Alloc 2018;16:6.
- 5. Centers for Disease Control U. Hepatitis B or C Infections and Breastfeeding. CDC web site, <https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/hepatitis-b-c.html#>. Accessed 27 Jul 2025.
Citations
Citations to this article as recorded by
