The yellow fever virus (YFV) 17D strain is one of the most effective live vaccines for human use, but the in vivo mechanisms for virulence attenuation of the vaccine and the corresponding molecular determinants remain elusive. The vaccine differs phenotypically from wild-type YFV by the loss of viscerotropism, despite replicative fitness in cell culture, and genetically by 20 amino acid changes predominantly located in the envelope (E) protein. We show that three residues in E protein domain III inhibit spread of 17D in extraneural tissues and attenuate virulence in type I/II interferon-deficient mice. One of these residues (Arg380) is a dominant glycosaminoglycan-binding determinant, which mainly accounts for more rapid in vivo clearance of 17D from the bloodstream in comparison to 17D-derived variants with wild-type-like E protein. While other mutations will account for loss of neurotropism and phenotypic stability, the described impact of E protein domain III changes on virus dissemination and virulence is the first rational explanation for the safety of the 17D vaccine in humans.The live, attenuated yellow fever virus (YFV) strain 17D vaccine has been used safely and effectively in over 500 million individuals over the past 70 years. This excellent safety record also underpins its potential application as a platform for chimeric vaccines against other medically important flaviviruses (dengue, Japanese encephalitis, and West Nile viruses), which are currently in clinical trials (reviewed in reference 13). Despite knowledge of the complete genome sequences of 17D (33) and its virulent parent (10), the Asibi strain isolated in Africa in 1927, the in vivo mechanism(s) and molecular determinants for virulence attenuation of the YFV vaccine are still not completely resolved. YFV strain 17D was the first human vaccine derived from repeated passage in tissue culture (reviewed in reference 39). More than 230 passages in embryonic mouse tissue (18 passages), chicken embryo tissue (50 passages), and chicken embryo tissue from which the head and spinal chord had been removed (152 passages) separate the 17D from the Asibi strain. The adaptation of 17D to growth in mouse and chicken embryonal tissues culture has resulted in loss of viscerotropism, a property which accounts for the major disease manifestations of yellow fever in primates: high viremia, hepatitis, renal dysfunction, hemorrhagic fever, and circulatory shock (reviewed in reference 28); it also resulted in reduced neurotropism and loss of tropism for mosquitoes, the obligatory vector in the natural transmission cycle of YFV. The complex passage history of YFV strain 17D has given rise to as many as 68 nucleotide mutations and 32 amino acid changes in the viral RNA genome (10). However, when the Asibi genome is compared to the consensus sequence of different 17D vaccine strains derived from it, the number of differences potentially contributing to the attenuated virulence phenotype can be reduced to 20 amino acids and 4 nucleotides in the 3Ј untranslated region...