Immunoprophylaxis reduces but does not completely eradicate hepatitis B virus (HBV) transmission. This prospective study aims at assessing the rate and risk factors of maternally transmitted HBV infection.We enrolled 303 mother-infant pairs with positive maternal hepatitis B surface antigen (HBsAg) under current immunization program. Maternal viral load was determined by a real-time PCR-based assay. The children were tested for HBsAg at 4–8months and/or 1–3years of age. Rates of HBV infection were estimated using a multivariate logistic regression model.HBeAg-positive mothers (81/303, 26.7%) had higher viral loads than HBeAg-negative mothers (7.4±1.9 vs. 2.7±1.4 log10 copies/ml, p<0.0001). Ten children, born to HBeAg-positive mothers with high viral load (median, 8.4; range, 6.5–9.5log10copies/ml), were chronically infected. After adjustment for maternal age, birth type, factors related to maternal-fetal hemorrhage, gestational age, infant gender, birth weight, timeliness of vaccination, and feeding practice, maternal viral load was significantly associated with risk of infection (adjusted odds ratio for each log10copy/ml increase, 3.49; 95% confidence interval (CI), 1.63–7.48; p=0.001). The predictive rates of infection at maternal viral load levels of 7, 8, and 9log10copies/ml were 6.6% (95% CI, 0.5–12.6%; p=0.033), 14.6% (95% CI, 5.6–23.6%; p=0.001), and 27.7% (95% CI, 13.1–42.4%; p<0.001), respectively.Additional strategies to further reduce transmission should be considered in mothers with a viral load above 7–8log10copies/ml.