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Background In winter 2024–25, surges in hMPV activity renewed public health interest, but no targeted therapy or vaccine is currently available. Better understanding of hMPV’s clinical features may aid diagnosis and treatment development.Objectives To characterise clinical and biochemical features of adults hospitalised with hMPV compared with influenza A and RSV.Methods The UNIVERSAL study is a UK multicentre prospective cohort investigating adults hospitalised with respiratory viral infections. Adults with acute respiratory infection underwent PCR testing. Clinical, radiological, and laboratory data were collected prospectively. Patients with confirmed hMPV, influenza A, or RSV were included.Results Between August 2022 and May 2025, 186 influenza A, 110 RSV, and 27 hMPV cases were included. Median age was 71 years (IQR 60–77) in hMPV, 68 (IQR 58–75) in RSV, and 64 (IQR 55–74) in influenza A, p = 0.063. Influenza vaccination was reported in 88/185 (48%) influenza A, 80/110 (73%) RSV, and 22/26 (85%) hMPV patients, p < 0.001. Five COVID-19 vaccines were recorded in 16/26 (62%) hMPV versus 47/108 (44%) RSV and 48/184 (26%) influenza A, p = 0.001. Median Charlson Comorbidity Index was highest in RSV 7 (IQR 4–13) versus influenza A 4 (IQR 4–10) and hMPV 5 (IQR 4–12), p = 0.047.Median neutrophil-to-lymphocyte ratio was lowest in hMPV 5 (IQR 3–7) versus influenza A 8 (IQR 4–13) and RSV 7 (IQR 5–14), p = 0.040. Median lymphocyte count was highest in hMPV (1.10 ×109/L, IQR 0.70–2.00), p = 0.032.Radiographic consolidation was reported in 8/21 (38%) hMPV versus 21/85 (25%) RSV and 34/136 (25%) influenza A patients, (p = 0.419). Median hospital stay was shortest in hMPV, 3 days (IQR 2–5) versus RSV 4 (IQR 3–7) and influenza 4 (IQR 2–6), p = 0.039. No hMPV patients required HDU/ICU versus RSV 4/106 (3.8%) and influenza 9/174 (5.2%). Mortality at 60 days occurred in 3/101 RSV (3.0%) and 5/166 influenza (3.0%), with 0/23 (0%) in hMPV.Abstract P178 Table 1Patient characteristics by virus – influenza A, RSV and hMPVConclusions HMPV was associated with less disruption of clinical biomarkers, shorter hospital stay, and fewer severe outcomes. These findings support virus-specific phenotyping to improve care pathways.