Background: HBV horizontal and vertical transmission rate vary among population in different social communities. To know the leading cause of HBV transmission among a community would ease the planning and strategies to minimize the spread. The objectives were to determine the frequency of different mode of intra-familial spread of Hepatitis B among the infected index identified families of rural community of Peshawar. Methods: This was 18 months descriptive cross-sectional study conducted among married couples of a defined rural community of district Peshawar. After taking informed consent from 797 couples of rural community, 3 to 5 ml blood sample was collected from each respondents for HbsAg screening along with the required data collected using predesigned questionnaire using convenient sampling techniques. HbsAg positive cases were considered as HBV index. Index case of both Hbs Ag positive parents were decided based on past history, previous exposure, past diagnosis and treatment record. The spouses and children of index cases were screened for serological determinants like HbsAg, HbeAg and ALT. Data was gathered and analyzed using SPSS version 16.0. Results: A total of 797 couples (1593 parents) were selected with proportion of household from ten different blocks of village Budhni. The prevalence of HBV infection among parents was found 1.5%. Nineteen HBV index families were detected among 797 parents screened for HbsAg. Spouse transmission rate of HBV were found 26.3% on average Transmission of HBV infection rate from index mother to children was 11.8%. About 10.5% index females were HbeAg positive. Conclusion: HBV transmission was high among the spouses followed by vertical transmission in a rural community of district Peshawar.