Visceral leishmaniasis (VL) is a neglected disease with worldwide distribution. Brazil is the country with the largest number of cases in the Americas, and the state of Minas Gerais presents a high VL-related burden and a high case fatality rate. We aimed to analyse the spatial and spatiotemporal patterns of VL occurrence and to identify priority risk areas for surveillance and control in the metropolitan region of Belo Horizonte-MG, the third largest metropolitan area in Brazil. An ecological study was conducted considering all cases of VL in humans confirmed from 2006 to 2017. The crude and smoothed incidence rates were used to analyse the distribution patterns of the disease (dispersed, random, or clustered) based on global and local indicators of spatial association and space–time risk assessment. Positive spatial autocorrelation and spatial dependence were found between incidence rates. It was possible to observe a high concentration of VL cases in the metropolitan core area, with the identification of two high-risk clusters in strictly urban areas, showing an urban association with the disease. Ten municipalities were categorised as high risk for VL occurrence. Our results provide evidence for making decisions in surveillance programs, suggesting the prioritisation of the municipalities with more risk of transmission.

内脏利什曼病（VL）是一种被忽视的疾病，分布在世界各地。巴西是美洲病例数最多的国家，而米纳斯吉拉斯州（Minas Gerais）的VL相关负担高，病死率高。我们旨在分析VL发生的时空格局，并确定在巴西第三大都市区贝洛奥里藏特-MG大都市区进行监视和控制的优先风险区域。进行了一项生态研究，考虑了2006年至2017年确诊的所有VL病例。根据全球和局部空间指标，使用粗略和平滑的发病率来分析疾病的分布模式（分散，随机或聚集）关联和时空风险评估。在发病率之间发现正空间自相关和空间依赖性。通过在严格的城市地区识别出两个高风险群，可以发现大城市中心地区的VL病例高度集中，表明该病与城市有关。十个城市被归类为VL发生的高风险。我们的结果为在监视计划中做出决策提供了证据，表明优先考虑具有更大传播风险的市政当局。