ISSN: 0973-7510

E-ISSN: 2581-690X

Research Article | Open Access
Akmal Shukri Amir Muhaimin1, Muhammad Amin Ibrahim2,
Mohammed Fauzi Abdul Rani2, Mariam Mohamad3, Seok Mui Wang4-6,
Ariza Adnan4, Madyhah Abd. Monir7,8, Fatmawati Kamal7,8 and Siti Farah Alwani Mohd Nawi4,8
1Institute of Medical Molecular Biotechnology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
2Respiratory and Sleep Diagnostic Unit, Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
3Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
4Department of Medical Microbiology and Parasitology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
5Non-Destructive Biomedical and Pharmaceutical Research Center, Smart Manufacturing Research Institute (SMRI), Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.
6Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
7Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia.
8Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.
Article Number: 11303 | © The Author(s). 2026
J Pure Appl Microbiol. 2026;20(2):1278-1293. https://doi.org/10.22207/JPAM.20.2.15
Received: 08 January 2026 | Accepted: 12 March 2026 | Published online: 05 May 2026
Issue online: June 2026
Abstract

The dynamics and protectiveness of the hybrid immune responses, especially in individuals who have experienced severe COVID-19, remain to be fully understood. This study aims to identify the prevalence and persistence of neutralising antibodies throughout time, and to investigate the longitudinal profile of anti-SARS-CoV-2 IgG antibodies targeting the receptor binding domain (RBD) in patients recovering from severe COVID-19. A total of 42 hospitalised COVID-19 survivors were enrolled from three medical centres in Malaysia. Serial blood samples were collected at four time points post-discharge (approximately 90, 180, 270 and 360 days). IgG titres were quantified using ELISA and neutralising antibodies (NAbs). Statistical analyses were performed to explore antibody dynamics and correlations. Among 42 participants, 24 completed all four visits. Mean antibody titre showed an initial decline after the first visit, followed by a gradual increase over time, with the highest being at Visit 4 (360-390 days post-discharge). The highest titre (266.7 ± 30.9 BAU/mL) was observed in a recipient, 10 days after receiving the fourth vaccination. All participants except one demonstrated protective NAbs at the final visit. Higher BMI was significantly associated with disease severity (P = 0.006), while IgG titres were higher in individuals with more severe initial infections (Category 5). This study highlights the persistence of antibody response with hybrid immunity, with the booster vaccinations contributing to increased antibody titres. RBD-specific IgG titres provide useful insights into their trends, while the concurrent NAbs assessment is important for a comprehensive understanding of the protective efficacy following hybrid immunity.

Keywords

COVID-19, Neutralising Antibodies, Immunoglobulin G (IgG), Hybrid Immunity, Antibody Persistence, Booster Vaccination, ELISA

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© The Author(s) 2026. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License which permits unrestricted use, sharing, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.